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INSOMNIA; 


AND    OTHER 


Disorders  of  Sleep. 


HENRY  M.  LYMAN,  A.M.,  M.D., 

Professor  of  Physiology,  and  of    Diseases  of  the  Nervous  System,  in  Rush  Medical 

College  ;  Professor  of  Theory  and  Practice  of  Medicine,  in  the 

"Woman's  Medical  College  ;   and  Physician  to  the 

Presbyterian  Hospital,  Chicago,  111. 


CHICAGO: 
W.     T.     KEENER, 

96  WASHINGTON  STEEET. 

1885. 


COPYRIGHT,     1885. 


B.   B.    DONXBLLEY   &  60N8,   PEINTEB8,   CHICAGO. 


PREFACE. 


Tired  Nature's  sweet  restorer,  balmy  sleep. 

— YOTTNG. 

The  regularly  recurring  incidence  of  natural  sleep 
forms  one  of  tlie  most  important  subjects  for  physio- 
logical inyestigation.  Were  it  an  event  of  rare  occur- 
rence, it  would  excite  a  degree  of  astonishment  and 
alarm  equal  to  the  agitation  now  experienced  by  the 
spectator  of  an  ordinary  attack  of  syncope  or  of 
epileptic  convulsion.  But,  so  completely  does  the 
recurrence  of  sleep  harmonize  with  all  the  other  facts 
of  life  that  we  are  as  indifferent  to  its  nature  as  we 
are  to  every  other  healthy  function  of  the  body.  It  is 
only  when  the  mind  has  undertaken  a  critical  observa- 
tion of  the  bodily  and  mental  changes  which  accom- 
pany and  condition  the  phenomenon  that  we  begin  to 
comprehend  its  wonderful  character.  Ushered  in  by 
a  waning  activity  of  body  and  mind  that  no  effort  of 
the  will  can  long  resist,  nothing  could  more  forcibly 
suggest  the  idea  of  approaching  dissolution  if,  from 
the  very  earliest  period  of  unconscious  infancy, 
we  had  not  been  accustomed  to  the  dominion  of  this 
imperious  necessity.  The  remarkable  likeness  between 
the  fading  of  consciousness  in  sleep  and  its  extinction 

(iii) 


IV  PREFACE. 

in  death  has,  in  all  ages  and  among  all  people,  arrested 
the  attention  of  poets  and  philosophers  of  every 
degree. 

Soft  repose, 
A  living  semblance  of  the  grave, 

sang  old  Thomas  Miller;  and,  describing,  in  Milton's 
stately  verse,  the  close  of  his  first  day  in  the  garden  of 
Eden,  Adam  says: 

Gentle  sleep 
First  found  me,  and  with  soft  oppression  seized 
My  drowsy  sense,  untroubled,  though  I  thought 
I  then  was  passing  to  my  former  state 
Insensible,  and  forthwith  to  dissolve. 

How  wonderful  is  death, 
Death  and  his  brother.  Sleep! 

exclaims  Shelley,  echoing  the  marvellous  strains  that 
have  come  down  to  us  from  the  days  of  Homer  and 
Hesiod.  In  that  venerable  literature  Sleep  and  Death 
are  represented  as  twin  brothers,  sons  of  Night ;  dwell- 
ing in  the  lower  world  of  spirits,  whence  they  come 
forth  to  perform  the  will  of  the  Olympian  Gods. 

The  prosaic  genius  of  our  scientific  generation  no 
longer  tolerates  such  lively  exercise  of  the  imagina- 
tion. The  splendid  anthropomorphism  of  the  Hebrew 
poet,  looking  out  upon  the  silent  night,  and  cheering 
his  soul  with  the  sonorous  exclamation. 

Behold,  he  that  keepeth  Israel 
Shall  neither  slumber  nor  sleep 


For  so  he  giveth  his  beloved  sleep, 

has  become  a  mere  memory  of  childhood.     Words- 


PREFACE.  V 

worth  understood  the  full  significance  of  this  change 
when  he  wrote: 

There  was  a  time  when  meadow,  grove,  and  stream, 
The  earth,  and  every  common  sight, 
To  me  did  seem 
Apparelled  in  celestial  light, 
The  glory  and  the  freshness  of  a  dream. 
It  is  not  now  as  it  has  been  of  yore; 
Turn  whereso'er  I  may, 
By  night  or  day. 
The  things  which  I  have  seen  I  now  can  see  no  more ! 

I  know,  where'er  I  go, 
That  there  has  passed  away  a  glory  from  the  earth. 

If,  however,  despite  the  loss  of  much  that  was 
beautiful  and  attractive  in  the  myths  of  antiquity,  we 
take  advantage  of  the 

Years  that  bring  the  philosophic  mind, 

we  shall  surely  find  in  the  scientific  investigation  of 
sleep  enough  to  awaken  "thoughts  too  deep  for" 
words. 


CONTENTS. 


CHAPTER    I. 

THE   NATURE   AND    CAUSE    OF    SLEEP. 

Definition  of  sleep — The  invasion  of  sleep — The  hypnagogic  state — 
Depth  and  duration  of  sleep — Diagrammatic  illustration  of  the 
phases  of  sleep — Modifications  of  physiological  functions  pro- 
duced by  sleep — Effect  of  sleep  upon  the  processes  of  respira- 
tion, circulation,  calorification,  secretion,  and  nutrition — Conse- 
quences of  the  progressive  invasion  of  the  nervous  system  by 
sleep — Effect  upon  the  organs  of  special  sense — Effects  observed 
in  the  muscular  apparatus  of  the  body — Condition  of  intellectual 
functions  during  the  invasion  of  sleep — Does  the  mind  ever 
sleep  ?  — Arguments  adduced  by  Sir  William  Hamilton  and 
others  to  prove  the  continued  activity  of  the  mind  during  the 
sleep  of  the  brain — Reasons  for  supposing  that  the  mind  may 
sleep — Variability  of  the  depth  of  sleep — Experiments  of  Kohl- 
schiiter  to  estimate  the  degree  of  variation — Alternation  of  day 
and  night  considered  as  a  cause  of  sleep — Diminution  of  sensa- 
tion a  cause  of  sleep — Illustrative  observation  by  Strumpell— 
Fatigue  a  cause  of  sleep — Hypothesis  of  Obersteiner  regarding 
the  cause  of  sleep — Hypothesis  of  Pfluger — Production  of  arti- 
ficial sleep  by  impregnation  of  the  brain  with  narcotic  sub- 
stances— Analogous  production  of  natural  sleep  by  accumulation 
of  cerebral  waste-products — Observations  regarding  the  duration 
of  sensory  impressions  requisite  for  the  excitement  of  conscious 
perception  —  Difference  between  syncope  and  sleep — Observa- 
tions of  Mosso  regarding  the  state  of  the  cerebral  circulation 
during  sleep — Cause  of  the  change  in  the  cerebral  circulation 
during  sleep — Molecular  conditions  necessary  for  the  production 
of  sleep — Somnolence  —  Sleeping  Dropsy,  or  Maladie  du  Som- 
meil — Coma — Lethargy — Apparent  death — Lucid  lethargy. 

(vii) 


Vlll  CONTENTS. 

CHAPTER    II. 

INSOMNIA,    OR    WAKEFULNESS. 

Causes  of  insomnia — Affections  of  the  organs  of  special  sense — 
Effects  of  light — Effect  of  sound — Impressions  upon  the  organs 
of  smell  and  taste — Disturbances  caused  by  a  high  temperature — 
Atmospheric  and  electrical  disturbances — Effects  produced  by 
cold — Hibernation  of  animals — Disturbances  of  sleep  occasioned 
by  painful  sensations — Disorders  of  the  sympathetic  nerves — 
Morbid  states  of  the  central  nervous  organs  —  Disorders  of 
circulation  and  nutrition — Hypersemia  of  the  brain — Anaemia 
and  starvation  of  the  brain — Effects  of  tea  and  coffee — Effect  of 
alcohol — Inflammations,  degenerations,  and  tumors  affecting 
the  brain — Excitement  of  the  brain  by  diseased  conditions  of 
of  the  blood.         -  -  -         -         -          ..-.38 

CHAPTER    III. 

REMEDIES    FOR    INSOMNIA. 

Serious  consequences  of  insomnia — Its  relation  to  cerebral  diseases — 
Treatment  of  insomnia  by  moderation  and  control  of  the  cere- 
bral circulation  —  Remedial  agents — Nervous  stimulants  and 
nervous  sedatives  —  Heat  —  Baths  —  Massage  —  Electricity  — 
Counter-irritants  —  Food  —  Digitalis— Camphor — Musk— Vale- 
rian— Cannabis  indica  —  Belladonna  —  Hyoscyamus  —  Stramo- 
nium — Phosphorus  — Acids  —Opium— Cold  — Alcohol  —  Paral- 
dehyde— Ether — Chloroform — Chloral — Butylchloral  hydrate — 
Amyl  nitrite  —  Opium  and  opiates  —  Bromides  —  Hops  — 
Gelsemium — Conium. __56 

CHAPTER   IV. 

TREATMENT    OF    INSOMNIA    IN    PARTICULAR    DISEASES. 

Insomnia  in  acute  affections  of  the  brain — In  insanity — In  chronic 
alcoholism  and  delirium  tremens  —  In  diseases  of  the  heart  and 
blood-vessels — In  angina  pectoris — In  diseases  of  the  respira- 
tory organs — In  asthma — In  renal  diseases — In  diseases  of  the 
liver — In  gastro-intestinal  diseases — In  febrile  conditions — In 
rheumatism  and  gout — In  lithsemia — In  syphilis — In  disorders 
of  nutrition  —  During  pregnancy  and  after  parturition  —  In 
spasmodic  diseases — In  childhood — In  old  age.  -         -         -     92 


CONTENTS.  IX 

CHAPTER  V. 

DREAMS. 

Physiology  of  perception  and  of  dreaming — Definition  of  the  act  of 
dreaming — Revery — Production  of  illusions  and  hallucinations 
by  drugs  and  by  disease — Effects  of  hasheesh — Effects  of  acute 
disease — Association  of  ideas — Memory  of  past  sensations — 
Dreams  produced  by  excitement  of  the  different  organs  of 
sense — Persistence  of  dream-impressions  after  wakmg — Experi- 
ence of  M.  Baillarger — Of  Professor  Jessen — Belief  of  savages 
in  the  reality  of  dreams — Sensory  dreams — Intellectual  dreams 
— Repetition  of  dreams — Incoherence  of  dreams — Cause  of  the 
superior  vividness  of  certain  dreams — Duration  of  dreams — 
Dreams  excited  by  morbid  states  of  the  body — Prophetic 
dreams — Their  causes  —  Clairvoyant  dreams — Hallucinatory 
dreams — Sir  Edmund  Hornby's  experience — Hallucinations — 
Case  related  by  Dr.  E.  H.  Clarke — Revelation  through  dreams 
— Revival  of  memory  in  dreams.         -         -         -         -         -  ii6 


CHAPTER  VI. 

SOMNAMBULISM. 

Causes  of  somnambulism — Physiology  of  somnambulism — Varieties 
of  the  disorder — Maury's  classification — Classification  of  Ball  and 
Chambard — Diagrammatic  representation  of  their  classification 
— Somnambulic  lethargy — Illustrative  cases — Somnambulic 
dreams — Night  terrors — Somnolentia  or  sleep-drunkenness — 
Sleep-walking — Illustrative  cases — Condition  of  the  special 
senses  in  somnambulism — Relation  of  memory  to  the  somnam- 
bulic paroxysm — Illustrative  cases — Occasional  recollection  of 
incidents  connected  with  the  somnambulic  dream— Resem- 
blances between  the  somnambulic  state  and  the  condition  of 
post-epileptic  mania — Somnambulic  visions — J.  P.  Frank's 
case — Mesnet's  case — Somnambulic  life — Its  likeness  with  the 
double-consciousness  of  certain  forms  of  epilepsy — Illustrative 
cases — General  theory  of  somnambulism.  -         .         .         .     i66 


X  CONTENTS. 

CHAPTER  VII. 

ARTIFICIAL    SOMNAMBULISM    OR    HYPNOTISM. 

Antiquity  of  the  phenomena  of  hypnotism — Modern  observations — 
Physical  conditions  favorable  to  the  phenomena — Methods  of 
inducing  the  hypnotic  state — Duration  of  hypnotic  sleep — Rudi- 
mentary states  of  hypnotism — Investigations  of  the  Society  for 
Psychical  Research — Mind-reading — Physiological  explanation 
of  the  process — Charcot's  observations  on  artificial  somnam- 
bulism— Cataleptic  variety  of  the  hypnotic  state — Lethargic 
variety  —  Somnambulic  variety  —  Hypnotic  clairvoyance  — 
Exalted  sensibility  of  the  brain  in  hypnotic  states — Suscepti- 
bility to  suggestions  from  without — Phenomena  of  so-called 
spiritualism  —  Table-rapping  — Planchette — Therapeutical  em- 
ployment of  hypnotism — Metaphysical  healing.         -         .         -    212 


CHAPTEE  I. 

THE  NATURE  AND  CAUSE  OP  SLEEP. 

Worn  out,  friend,  is  every  theory, 
But  green  the  golden  tree  of  life. 


— Goethe. 


Natural  sleep  is  that  condition  of  physiological 
repose  in  which  the  molecular  movements  of  the 
brain  are  no  longer  fully  and  clearly  projected  upon 
the  field  of  consciousness.  This  condition  is  univer- 
sally observed  in  all  healthy  animals ;  and  its  recur- 
rence is  intimately  associated  with  the  diurnal  revolu- 
tion of  the  earth,  and  the  succession  of  day  and  night. 
The  disappearance  of  daylight  is,  for  the  majority  of 
living  creatures,  the  signal  for  cessation  of  active  life. 
Though  its  onset  may  be  for  a  time  delayed  by  an 
effort  of  the  will,  the  need  of  rest  at  length  overcomes 
all  opposition,  and  the  most  untoward  circumstances 
cannot  then  prevent  the  access  of  unconsciousness. 
The  story  of  the  sailor-boy,  sleeping  on  "  the  high  and 
giddy  mast,"  is  familiar  to  every  one.  An  officer  in  the 
United  States  Navy  has  assured  me  of  more  than  one 
instance  in  which  men  had  fallen  asleep  under  his  own 
eyes,  oppressed  by  exhaustion,  during  the  roar  of  a 
long  continued  bombardment.  Thus  produced,  the 
relation  of  cause  and  effect  between  weariness  and 
sleep  becomes  very  apparent.  The  refreshing  influ- 
ence of  such  repose  points  clearly  to  the  restorative 

(1) 


2  INSOMNIA. 

character  of  the  physiological  processes  which  persist 
during  the  suspension  of  consciousness.  It  also  ren- 
ders evident  the  final  cause  of  that  periodical  interrup- 
tion of  activity  which  the  brain  experiences  in  com- 
mon with  every  other  living  structure. 

Sleep  is  usually  preceded  for  some  time  by  a  feeling 
of  sleepiness.  This  sensation,  like  the  analogous  sen- 
sations of  hunger  and  thirst,  represents  in  some  meas- 
ure the  progressive  diminution  of  energy  throughout 
the  entire  body ;  but  it  is  chiefly  expressive  of  the  fail- 
ure of  cerebral  energy.  It  produces  a  sense  of  gen- 
eral heaviness  and  intellectual  dullness;  the  special 
senses  become  less  alert,  the  eyelids  droop,  numerous 
groups  of  muscles  experience  the  spasmodic  contrac- 
tion of  yawning,  the  head  drops  forward  and  is  recov- 
ered with  a  jerk,  the  limbs  relax,  and  the  whole  body 
tends  to  assume  a  position  convenient  for  repose. 
Every  school-boy  who  has  been  compelled  to  pass  an 
evening  hour  at  a  dull  lecture,  under  the  eye  of  a 
martinet  monitor,  will  testify  to  the  suffering  which 
attends  any  unusual  prolongation  of  this  period.  But, 
if  the  natural  course  of  events  be  not  obstructed,  the 
stage  of  mere  sleepiness  is  soon  passed,  and  the  intro- 
ductory stage  of  sleep  is  entered.  This  is  a  state  in 
which  the  individual  is  neither  awake  nor  fully  asleep. 
It  is  known  as  the  hypnagogic  state.  During  this 
period  the  phenomena  of  simple  sleepiness  become 
exaggerated  to  such  a  degree  that  the  attitude  of 
repose  is  assumed  without  effort  if  the  body  be  per- 
mitted to  follow  the  natural  inclination  of  its  different 
members.  The  eyes  close,  the  other  senses  become 
inactive,  though  the  sense  of  hearing  is  the  most  per- 


THE  INVASION   OF   SLEEP.  3 

sistent.  Eeleased  in  considerable  measure  from  the 
control  of  the  brain,  the  reflex  energy  of  the  spinal 
cord  is  at  first  somewhat  exalted.  Witness  the  fibril- 
lary twitching  of  the  muscles,  and  the  convulsive  state, 
which  may  often  be  observed  during  the  stage  of  som- 
nolence after  severe  fatigue.  The  uneasy  sleeper  may 
even  be  roused  to  complete  wakefulness  by  such  invol- 
untary movements.  But,  as  sleep  becomes  more  pro- 
found, the  reflex  functions  of  the  cord  are  also  weak- 
ened.^ As  the  sensory  organs  retire  from  action, 
the  intellectual  faculties  lose  their  equilibrium.  First, 
the  power  of  volition  ceases.  Then  the  logical  asso- 
ciation of  ideas  comes  to  an  end.  The  reasonino- 
faculty  disappears,  and  judgment  is  suspended.  We 
become,  therefore,  no  longer  capable  of  surprise  or 
astonishment  at  the  vagaries  of  memory  and  of  imag- 
ination, the  only  faculties  that  remain  in  action.  To 
their  more  or  less  unfettered  activity  we  owe  the  pre- 
sentation in  consciousness  of  those  disorderly  pictures 
which,  occurring  in  this  stage  of  imperfect  sleep,  have 
been  termed  hypnagogic  hallucinations.^  During 
the  early  moments  of  this  period  an  observant  person 
may  often  retain  a  power  of  reasoning  sufficient  to 
remark  the  fact  of  dreaming,  and  this  effort  of  atten- 
tion may  produce  a  partial  awakening;  but,  usually, 
the  subsidence  of  cerebral  function  is  progressive  and 
rapid.  The  fire  of  imagination  fades,  the  field  of  con- 
sciousness becomes  less  and  less  vividly  illuminated, 
the  entire  nervous  apparatus  yields  to  the  advancing 
tide,   and,  finally,  the  dominion  of  sleep  is  fully  con- 

^  Rosenbach,  Zeitschr.  f.  klin.  med,  1881.     Brain,  Vol.   IV,  p.  138. 
'  Alfred  Maury,  Le  Sonntieil  et  les  Reves,  Chap.  IV. 


INSOMNIA. 


firmed.  The  sleeper  knows  nothing  of  the  external 
world,  and  has  lost  all  consciousness  of  his  own  exist- 
ence. But  the  duration  of  profound  repose  is  brief. 
From  the  end  of  the  first  hour  the  depth  of  sleep,  at 
first,  rapidly,  then,  more  gradually,  subsides.  Dreams 
disturb  its  tranquility,  mental  activity  increases,  the 
power  of  volition  revives,  and,  at  the  end  of  six  or 
eight  hours,  the  individual  is  once  more  awake.  The 
subjoined  diagram,  borrowed  from  the  Dictionaire 
Encyclopedique  des  Sciences  M6dicales,  will  facilitate 
the  apprehension  of  these  successive  phases  in  the 
course  of  sleep: 


6 
S3 

eS 

o 

6 

CO 

o 
o 

aa 

C 

o 

> 

a 
"5) 

eS 
S 

at 

9 

o 

c3 
> 

a 
■p 

:3 

o 

•a 

u 

a?' 

02 

« 

1         1 

Normal  life. 

1        1 

1         1        1 

First  stage  of  sleep — Hypnagogic  hal- 
lucinations. 

1         1       " 

^^ 

1         1 

Second  stage  of  sleep — Dreaming. 

Third  stage  of  sleep. 

^^^^^^^^ 

1 

^^_ 

Profound  sleep. 

^^ 

First  stage  of  waking. 

1         1    ■ 

Second  stage  of  waking — Dreams. 

1              1 

1         1         1 

Third  stage  of   waking— Hypnagogic 
hallucinations. 

1         1         1 

till 

Complete  awakening. 

1         1        1         1 

RESPIRATION  DURING  SLEEP.  o 

It  was  formerly  believed  that  during  the  time  of 
sleep  all  the  processes  of  assimilation  and  nutrition 
throughout  the  body  are  increased, — in  short,  that  it 
is  the  season  of  repair  for  the  waste  of  tissue  incurred 
during  the  hours  of  wakeful  activity.  While  it  is  true 
that  in  sleep  the  expenditure  of  force  is  greatly 
reduced,  the  more  exact  researches  of  modern  physi- 
ologists indicate  a  universal  reduction  in  the  rate  of 
all  the  vital  processes.  The  final  result,  however,  is  a 
general  renewal  of  energy,  because  the  aggregate 
income  of  the  tissues  is  greater  than  their  outgo  during 
the  suspension  of  conscious  activity.  The  following 
observations  make  very  apparent  the  fact  of  a  reduc- 
tion of  physiological  activity: 

Respiration. — The  process  of  breathing  is  con- 
ducted with  greater  deliberation  during  the  period  of 
sleep.  This  reduction  is  one  of  the  most  notable  of 
the  circumstances  that  first  attract  the  attention  of 
the  spectator  who  observes  a  sleeping  person.  The 
average  number  of  respirations  per  minute,  in  an 
adult  of  twenty-five  to  thirty  years  of  age,  is  sixteen. 
Quetelet  remarked^  that  during  sleep  this  number  was 
diminished  by  about  one-fourth.  The  same  fact  has 
been  recorded  by  other  observers.^  Mosso  has  also 
noted  the  fact  ^  that  there  is  a  change  in  the  type  of 
respiration,  the  movements  during  sleep  become  less 
diaphragmatic  and  more  largely  costal.  He  further- 
more observed  that  during  the  waking  period  the 
act   of  inspiration    consumed    8-12   of   the    complete 

'  Hermann's  Handbuch  der  Physiologie,  Vol.  IV,  Part  II,  p.  g8. 
'  Handbuch  der  Kinderkrankheiten,  Vol.  I,  p.  346. 
^  Handbuch  der  Physiologie,  Vol.  IV,  Pt.  II,  p    217. 


6  INSOMNIA. 

respiratory  phase,  but  during  sleep  it  was  prolonged 
till  it  occupied  10-12  of  the  same  cycle.  The  interval 
between  the  end  of  expiration  and  the  commencement 
of  inspiration  was  also  obliterated  by  sleep.  Notwith- 
standing this  relative  increase  of  inspiratory  motion, 
the  quantity  of  air  that  passes  through  the  lungs  is 
considerably  reduced  by  reason  of  the  diminished 
action  of  the  diaphragm.  A  corresponding  reduction 
of  the  gaseous  exchanges  between  the  blood  and  the 
external  air  has  been  determined  by  the  experiments 
of  Pettenkofer  and  Voit,  Boussingault,  Lewin,  and 
other  equally  competent  observers.' 

Circulation. — During  sleep  the  heart  beats  less  fre- 
quently than  during  the  waking  hours.  Though  a 
portion  of  this  delay  must  be  attributed  to  the  recum- 
bent position,  sleep  does  still  further  retard  the  move- 
ment of  the  heart.  My  own  observations  upon  children 
in  bed  exhibit  a  difference  of  twelve  to  sixteen  beats 
between  the  pulsations  Avhen  awake  and  asleep.  Ac- 
cording to  Trousseau^  the  average  number  of  pulsa- 
tions observed  in  a  group  o  f  thirty  children,  varying  in 
age  from  fifteen  days  to  six  months,  was  140  when  awake 
and  121  when  asleep.  In  another  group  of  twenty- 
nine  cliildren,  between  the  ages  of  six  months  and 
twenty-one  months,  the  average  was  128  when  awake 
and  112  when  asleep.  The  observations  of  Hohl  and 
Allix^  indicate  that  among  very  young  children  the 
difference  between  the  pulse  of  sleep  and  the  pulse 
of  wakefulness  may  equal  forty  beats.     According  to 

'  op.  at.,  pp,  142  and  456. 

^  Die.  Encyc.  des  Sci.  MM.,  Art.  Sommeil,  pp.  277. 

^Quoted  by  Vierordt,  Handbuch  der  Kinderkrankheiten,  Vol.  I,  p  307. 


TEMPERATURE  DURING  SLEEP.  7 

Guy  (loc.  cit)  the  pulse  is  more  variable  in  the  morn- 
ing than  during  the  afternoon  or  evening. 

Temperature. — Aside  from  the  almost  hourly  fluc- 
tuations of  the  bodily  temperature,  a  noticeable  sink- 
ing of  the  temperature-curve  is  observed  during  the 
hours  of  sleep.  This  alone  is  sufficient  to  indicate  a 
diminished  rate  of  combustion  in  the  tissues.  Bous- 
singault  found  ^  that  a  dove  which  consumed  255  mille- 
grammes  of  carbon  every  hour  while  awake,  oxidized 
only  162  millegrammes  when  asleep.  Scharling  also 
observed  that  the  quantities  of  carbon  successively 
oxidized  by  the  same  man  when  asleep  and  awake  bore 
to  each  other  the  ratio  of  1 : 1.237.  The  observations  of 
Demme '  indicate  that  increase  of  bodily  temperature 
during  the  hours  of  sleep  must  be  considered  as  the 
result  of  pathological  processes  in  the  tissues.  The 
observations  of  Allix  (loc,  cit),  made  upon  sixteen  chil- 
dren during  the  first  twelve  days  after  birth,  showed 
an  average  fall  of  0°.38  C.  during  the  hours  of  sleep. 
Eight  children,  between  ^Ye  and  sixteen  months  old, 
exhibited  a  similar  depression  of  0°.56C. ;  while  ten 
children,  ranging  in  age  from  twenty  months  to  four 
years  of  age,  averaged  0°.34C.  less  when  asleep  than 
when  awake. 

The  well-known  experiments  of  Chossat,  who  found 
that  the  temperature  of  pigeons  was  from  0°.70  C  to 
0°.90  C.  higher  at  noon  than  at  midnight,  may  not  be 
considered  satisfactory  evidence  of  the  depressing  in- 
fluence of  sleep,  because  it  is  true  that  the  diurnal 
variations  of  temperature  which   are   conditioned  by 

^  Die.  Encyc.  des.  Med.,  le  serie,  t.  XV,  p.  75. 
"^  Handbuck  der  Kinderkrankheiten,  Vol.  I,  p.  383. 


8  INSOMNIA. 

the  vital  activities  of  every  animal  might  be  sufficient 
to  account  for  these  differences.  The  experiments  of 
Horvath'  are  more  convincing.  This  observer  found 
that  the  marmots  upon  which  he  experimented  were  ac- 
customed to  sleep  during  the  winter  for  about  four 
days  continuously,  and  would  then  remain  awake  for  an 
equal  length  of  time.  "During  the  sleeping  period 
they  can  be  cooled  down  to  such  a  degree  that  a  ther- 
mometer introduced  into  the  rectum  to  the  depth  of  an 
inch  and  a  half  indicated  only  3°F.  above  the  freezing 
point.  The  temperature  rose  rapidly  after  the  animal 
awoke,  so  that  in  the  course  of  an  hour  it  was  3°F. 
higher;  at  the  close  of  the  second  hour  9°F.  higher, 
and  at  the  end  of  the  next  half  hour  about  27 °r.  *  * 
Neither  respiration  nor  the  muscular  movements  were 
correspondingly  augmented."  This  observation  clearly 
shows  the  powerful  influence  of  cerebral  activity  upon 
the  liberation  of  heat  within  the  body. 

Secretion. — The  functions  of  the  numerous  glands 
throughout  the  body  are  diminished  during  sleep. 
The  tears  dry  up,  and  the  cornea  receives  less  mois- 
ture. Hence  the  stickiness  of  the  margins  of  the  eye- 
lids during  the  sleep  of  a  patient  suffering  with  conjunc- 
tivitis. He  can  open  his  eyes,  on  awaking,  only  after 
sufficient  time  has  elapsed  to  revive  the  lachrymal  flow. 
Exner*^  remarks  the  diminution  of  pathological  secre- 
tion in  nasal  catarrh  during  the  hours  of  sleep.  The 
mouth  in  like  manner  ceases  to  receive  its  full  quota  of 
saliva,  and  its  cavity  quickly  dries  if  the  lips  remain 
open.     The  secretions   of  the  gastro-intestinal  glands 

'  Carpenter's  Physiology,  8th  edition,  p.  560. 

"^  Handbuch  det  Physiologic,  Vol.  II,  Pt.  II,  p,  297. 


EFFECT   OF   SLEEP   ON   NUTRITION.  9 

Yaij  with  the  contents  of  the  alimentary  canal ;  but  in 
general  they  are  considerably  diminished,  and  diges- 
tion is  correspondingly  retarded  during  the  hours  of 
sleep.  The  quantity  of  urine  is  lessened  during  sleep.  ^ 
The  elimination  of  urea  and  of  other  excrementitious 
matters  is  less  during  the  night  than  by  day.^  Unless 
increased  by  disease,  or  by  accidental  circumstances 
connected  with  atmospheric  temperature  and  unneces- 
sary clothing,  the  perspiration  is  also  diminished. 

Nutrition. — All  the  molecular  processes  of  nutri- 
tion are  reduced  by  sleep.  The  lowering  of  the  bodily 
temperature  has  been  already  indicated.  The  observa- 
tions of  Helmholtz^  indicate  that  the  actual  libera- 
tion of  heat  in  the  tissues  is  but  little  more  than  one- 
third  of  the  amount  set  free  in  an  equal  period  of  time 
during  the  waking  hours.  The  numerous  experiments  ^ 
of  Boussingault,  Henneberg,  Scharling,  E.  Smith, 
Liebermeister,  Pettenkofer,  Yoit,  and  LeAvin,  clearly 
indicate  the  fact  that  during  sleep  less  oxygen 
is  absorbed,  and  less  carbonic  acid  gas  is  dis- 
charged, by  the  tissues.  Yoit  found  that  while, 
during  the  daytime,  435  grammes  of  oxygen  were 
taken  in  by  a  working  man,  only  326  grammes  were 
needed  by  the  same '  individual  during  the  noctur- 
nal half  of  the  day.  Artificial  sleep  occasioned  by 
chloral  hydrate  produced  a  similar  reduction  in  the 
consumption  of  oxygen  and  in  the  formation  of  car- 

*  Quincke,  Archiv.  f.  Experim.  Pathol.,  Vol.  VII,  p.  115. 
^Carpenter's  Physiology,  8th  edition,  p.  526,     Handbuch  der Kinder- 
krankheiten,  2d  edition.  Vol.  I,  p.  373. 

^  Die.  Encyc.  des  Sci.  Med.,  Ille  Serie,  Vol.  X,  p.  268. 
^Handbuch  der  Physio logie.  Vol.  V,  p.  142-156. 


10  INSOMNIA. 

bonic  acid  gas.  Under  the  influence  of  morphine 
the  reduction  of  COg.  reached  27  per  cent.,  and  the 
diminution  of  oxygen  amounted  to  84  per  cent,  of  the 
quantities  furnished  during  wakeful  activity.  The 
comparatively  small  reduction  (only  6  per  cent.)  in 
the  decomposition  of  the  nitrogenous  elements  of  the 
body  during  the  same  period,  exhibits  the  close  rela- 
tion between  the  metamorphosis  of  the  non-nitrogen- 
ous elements  of  the  tissues  and  the  amount  of  bodily 
activity. 

The  experiments  of  Pettenkofer  and  Yoit,  to  which 
allusion  has  just  been  made,  serve  also  to  illustrate  the 
fact  that  all  tissue  changes  are  increased  by  every 
excitement  of  the  sensory  organs  of  the  body,  but  are 
diminished  by  the  subsidence  of  peripheral  irritations. 
Hence  the  importance  of  quiet  and  darkness  when  we 
seek  to  induce  that  state  of  the  body  in  which  mole- 
cular processes  should  reach  their  minimum.  Since 
every  act  of  perception  is  attended  by  an  outburst  of 
refuse  matter  from  the  nervous  tissue,  the  quantity  of 
such  excrementitious  discharge  in  any  given  period  of 
time  becomes  in  some  sort  a  measure  of  the  vital 
activity  of  the  organism.  Conclusive  proof  of  the 
diminution  of  vital  function  during  sleep  is  thus  ob- 
tained. 

It  must  not,  however,  be  inferred  that  the  general 
reduction  of  tissue-change,  which  has  thus  been  estab- 
lished, during  the  hours  of  sleep,  is  evidence  of  a  uni- 
versal and  uniform  reduction  of  function  throughout 
the  body.  Sleep  seldom  falls  at  once  with  equal  force 
upon  every  organ  ;  its  invasion  is  progressive.  Con- 
sequently, certain  structures  may  be  fast  asleep,  while 


STATE   OF  THE   SPECIAL   SENSES  IX   SLEEP.       11 

others  are  partly  awake, — ^while  still  other  portions  of 
the  organism  may  be  in  a  condition  of  activity  greatly 
in  excess  of  their  ordinary  wakeful  function.  Upon 
this  fact  depend  the  phenomena  of  dreams  and  the 
various  forms  of  somnambulism.  The  special  senses  are 
usually  overcome  by  sleep  before  the  muscular  appa- 
ratus yields,  and  the  cerebro-spinal  nervous  centres  are 
the  last  of  all  to  succumb.  The  eyes,  for  example,  cease 
to  see  clearly  before  the  eyelids  drooj),  or  the  muscles 
of  the  neck  give  way  in  the  act  of  nodding.  The 
senses  of  touch  and  of  taste  fail  noxt  in  order,  as  in 
the  case  of  the  infant  gourmand,  who  may  be  seen 
falling  asleep  at  supper, —  his  mouth  yet  filled  with 
untasted  sweets  from  the  table  before  him.  The  sense 
of  smell  is  more  persistent,  and  its  exercise  is  some- 
times an  obstacle  to  the  invasion  of  sleep.  Witness 
the  effect  of  powerful  odors  upon  certain  persons.  The 
perfume  of  flowering  plants  in  the  sleeping  chamber 
is  sometimes  decidedly  annoying  on  this  account.  A 
lady  of  my  acquaintance  was  once  awakened  out  of  a 
sound  sleep  by  the  smell  of  tobacco  smoke  from  the 
pipe  of  a  thoughtless  burglar  who  had  quietly  entered 
a  distant  apartment  of  the  house.  A  sudden  change 
of  wind,  deluging  a  city  with  the  vapors  of  a  glue-fac- 
tory or  rendering  establishment,  may  in  like  manner 
disturb  the  slumbers  of  thousands  of  people. 

The  sense  of  hearing  seems  to  be  the  most  persist- 
ent of  all  the  special  senses.  It  is  not  a  very  uncom- 
mon thing  for  persons  to  be  awakened  by  the  sound  of 
their  own  snoring;  or,  if  not  actually  aroused  by  the 
noise,  to  remain  in  a  condition  of  repose  which  seems 
to  be  sustained  and  cheered  by  the  regular  rhythm  of 


12  INSOMNIA. 

its  own  music.  As  a  general  rule,  however,  it  is  note- 
worthy that,  when  not  wholly  dormant,  each  sense 
finds  its  sphere  of  activity  greatly  narrowed  by  the 
fact  of  sleep.  Consequently  the  range  of  perception, 
if  not  wholly  obliterated,  is  greatly  limited  during  the 
time  of  sleep. 

While  it  is  true  that  sleep  arrests  the  voluntary 
activities  of  the  muscles,  it  is  also  a  fact  that  all  the 
muscles  do  not  yield  at  once  or  in  equal  degree.  The 
extensors  of  the  neck,  and  the  supporters  of  the  spinal 
column,  are  the  first  to  fail.  The  patient  begins  to 
nod,  and  is  inclined  to  fall  forward,  before  conscious- 
ness ceases.  The  muscles  of  respiration  and  of  circu- 
lation continue  to  contract,  though  at  a  diminished 
rate.  The  vermicular  movements  of  the  intestinal 
coats  persist,  and  in  certain  conditions  of  ill-health 
their  exaggerated  contractions  may  become  a  cause  of 
imperfect  repose.  Reflex  movements  may  always  be 
excited  during  natural  sleep.  Tickling  the  sole  of  the 
foot  will  cause  retraction  of  the  limb;  and  before  the 
complete  establishment  of  sleep,  a  certain  exaltation  of 
the  spinal  reflexes  may  be  observed.  Young  children 
may  frequently  be  seen  in  the  act  of  suction  with  their 
lips,  as  if  at  the  breast;  and  the  smile  of  the  sleeping 
infant  is  a  matter  of  daily  remark  in  every  nursery. 
The  influence  of  dreams  as  an  excitant  of  muscular 
movement  will  be  hereafter  discussed. 

The  variation  of  intellectual  function  which  appears 
in  sleep  serves  to  measure  its  profundity  and  to 
indicate  the  extent  of  its  invasion.  The  act  of  per- 
ception being  dependent  upon  sensation,  it  is  to  be 
observed  that  the  range  of  perception  diminishes  so 


SLEEP   AND   THE   MENTAL   FUNCTIONS.  13 

soon  as  the  organs  of  sense  begin  to  yield.  Its  in- 
tensity may  not  immediately  fail,  but  the  breadth  of 
its  scope  is  narrowed.  Sometimes,  however,  the  act  of 
conscious  perception  is  arrested  before  the  organs  of 
sense  are  sealed.  The  sleepy  reader  may  continue  to 
eye  the  page  before  him,  perhaps  even  to  read  aloud 
for  a  considerable  time  after  he  has  ceased  to  derive 
any  meaning  from  the  words  of  the  book.  In  such 
cases  the  organs  of  perception  and  conception  and 
association  of  ideas  slumber  before  the  bonds  of  con- 
nection between  the  will  and  the  muscular  organs  have 
been  completely  relaxed.  Such  an  example  affords  a 
valuable  illustration  of  the  division  of  the  brain  into 
separate  mechanisms  which,  though  most  intimately 
related,  are  nevertheless  partially  independent  of  each 
other.  Sleep  may  operate  like  an  invasive  disease, 
falling  with  unequal  incidence  upon  the  different  struc- 
tures that  make  up  the  mass  of  the  brain,  paralyzing 
one  portion,  while  simply  benumbing  another,  and  even 
arousing  to  excessive  activity  a  third.  Consequently 
the  intellectual  functions  may  be  very  unequally  dis- 
turbed, and  the  order  of  their  subsidence  may  be  con- 
siderably varied ;  but,  as  a  general  rule,  the  physiologi- 
cal relations  of  the  faculties  are  respected,  so  that  as 
sensation  diminishes,  perception  fails,  the  conception 
of  ideas  is  correspondingly  hindered,  and  the  associa- 
tion of  such  ideas  as  are  still  projected  upon  the  field 
of  consciousness  becomes  more  imperfect.  The  loss  of 
the  power  of  association  implies  the  destruction  of 
memory  and  the  impossibility  of  exercising  the  rea- 
soning faculty  or  of  forming  those  judgments  upon 
which  every  act  of  volition  is  based.     When  the  brain 


14  INSOMNIA. 

« 
has  at  length  been  so  far  overwhelmed  that  physical 

impressions  can  no  longer  reach  the  field  of  conscious- 
ness, all  manifestation  of  intellectual  life  is  at  an  end, 
and  the  sleeper  sleeps  a  dreamless  sleep  that  leaves  no 
trace  behind. 

It  is  assumed  in  the  last  sentence  that  the  brain 
may  become  so  far  transformed  by  sleep  that  it  ceases 
for  the  time  to  be  capable  of  function  as  the  instru- 
ment of  thought.  This  conclusion  has  been  ques- 
tioned by  the  very  highest  authorities.  Sir  William 
Hamilton,  Exner,  and  many  others  have  instituted 
numerous  experiments  to  test  the  possibility  of  a 
dreamless  sleep.  Causing  themselves  to  be  suddenly 
aroused  at  all  hours  of  the  night,  they  invariably  found 
themselves  at  the  instant  of  awaking  occupied  with  the 
course  of  a  dream.  Hence  it  has  been  inferred  that  the 
mind  is  always  alert,  even  when  the  body  is  most 
thoroughly  asleep.  In  explanation  of  the  fact  that 
consciousness  contains  after  deep  sleep  no  trace  of  such 
mental  activity,  it  is  claimed  that  the  act  of  dreaming 
of  which  we  are  aware  at  the  moment  of  waking  is 
proof  of  intellectual  function  during  the  moments  which 
preceded  that  incident,  and  that  we  are  merely  forget- 
ful of  all  similar  processes  that  occurred  during  undis- 
turbed sleep.  The  unconsciousness  of  sleep,  according 
to  this  theory,  is  not  real — it  is  only  apparent  through 
failure  of  the  memory.  If  this  be  true,  memory  is  the 
only  intellectual  faculty  of  whose  inaction  we  can  be 
sure.  The  period  of  deep  sleep  might  then  be,  for  all 
we  know  to  the  contrary,  a  period  of  the  most  intense 
and  exalted  mental  activity.  But,  if  so,  it  is  quite 
worthless  as  a  constituent  of  our  conscious   existence. 


MENTAL   ACTION  DURING   SLEEP.  15 

It  may  also  be  objected  with  equal  reason  that  the 
dreams  which  unquestionably  occupy  the  field  of  con- 
sciousness at  the  instant  of  waking  are  probably  ex- 
cited by  the  impressions  which  terminate  sleep.  The 
process  of  waking,  though  often  very  greatly  hurried, 
is  by  no  means  absolutely  instantaneous.  As  we  shall 
learn,  the  time  requisite  for  the  evolution  of  a  dream 
may  be  indefinitely  brief.  Consequently,  it  seems 
better  in  all  such  instances  to  assign  the  period  of 
dreaming  to  the  time  of  diminishing  slumber  that 
corresponds  to  the  disturbance  by  which  sleep  was 
terminated. 

The  only  reason  for  any  hesitation  in  the  acceptance 
of  such  a  proposition  consists  in  the  reluctance  of  many 
philosophers  to  admit  the  possibility  of  any  interrup- 
tion in  the  active  life  of  a  spiritual  being,  such  as  man 
is  conceived  to  be.  But  it  is  difficult  to  comprehend 
any  valid  reason  for  the  denial  of  such  interruption. 
Every  form  of  force,  of  which  we  have  any  knowledge, 
is  subject  to  fluctuations  in  the  course  of  its  phenome- 
nal manifestation.  When  a  physical  force  ceases  to 
exhibit  itself  in  an  active  state,  and  passes  into  a  poten- 
tial modification,  we  are  not  compelled  to  regard  it  as 
extinguished.  It  is  merely  latent  or  inhibited,  but 
always  ready  to  take  its  place  again  among  the  kinetic 
forces  of  nature.  In  like  manner  there  seems  to  be  no 
good  reason  why  that  spiritual  force  or  congeries  of 
forces  which  constitutes  the  mind  of  man  may  not 
experience  analogous  transformations  in  successive 
periods  of  action  and  of  repose.  Such  periods  of  rest 
occur  in  sleep,  in  coma,  in  disease  and  disorganization 
of  the  brain.     The  mind  sleeps,  it  does  not  cease  to 


16  INSOMNIA. 

exist — probably    not    even   when   death    dissolves    its 
material  substratum. 

That  the  depth  of  sleep  is  exceedingly  variable  is 
evident  in  the  experience  of  every  one.  A  German 
physiologist'  has  made  a  rough  estimate  of  the 
soundness  of  sleep  by  comparing  the  loudness  of 
the  noises  necessary  to  wake  the  subject  of  experi- 
ment at  regular  intervals  during  the  course  of  the 
night.  He  arranged  a  gong  with  a  pendulum  attach- 
ment, and  noted  the  length  of  the  stroke  which  pro- 
duced a  sound  sufficiently  loud  to  awaken  the  patient. 
In  this  way  the  different  degrees  of  intensity  of 
the  awakening  noise  could  be  calculated,  and  the 
corresponding  depth  of  sleep  could  be  estimated.  It 
was  thus  concluded  that  the  depth  of  sleep  increases 
rapidly  during  the  first  hour,  at  the  end  of  which 
time  it  has  reached  its  maximum.  During  the 
next  half  hour  it  diminishes  as  rapidly  as  it  had 
increased  in  the  first  half  hour.  During  the  next 
hour  it  still  further  diminishes,  almost  as  much  as  it 
increased  during  the  second  half  hour.  The  remain- 
ing ten  half  hours  of  the  experiment  were  occu- 
pied by  a  comparatively  light  and  gradually  diminish- 
ing slumber,  until  the  vanishing  point  of  sleep  was 
reached  at  the  expiration  of  eight  hours  from  its 
commencement.  This  observation  corresponds  with 
the  general  opinion  that  sleep  is  deepest  in  the  early 
part  of  the  night.      For  the  same  reason  dreams  and 

'  Kohlschiitter,  Messungen  der  Festigkeit  des  Schlafes.  Dissert.  Leip- 
zig, 1862,  und  Zeitsch'ift  f.  rat.  Med..  1863.  Quoted,  Hermann's 
Handbuch  der  Physiologie,  Vol.  II,  Pt.  II,  p.  295. 


THE   CAUSES   OF   SLEEP.  17 

wakefulness  are  mo  si  frequent  during  the  early 
watches  of  the  morning. 

When  considering  the  causes  of  sleep  it  is  needful 
to  exclude  fi'om  view  those  artificial  varieties  of  sleep 
that  are  produced  by  the  various  narcotic  drugs,  as  well 
as  the  counterfeits  of  sleep  which  result  from  dis- 
eased conditions  of  the  body.  It  is  comparatively  easy 
to  frame  hypotheses  in  explanation  of  such  interrup- 
tions of  our  conscious  life;  but,  when  we  attempt  to 
formulate  a  theory  which  shall  satisfactorily  account 
for  the  occurrence  of  natural  sleep  in  healthy  ani- 
mals, the  task  becomes  exceedingly  difficult. 

First  among  the  causes  of  sleep  may  be  reckoned 
the  alternation  of  day  and  night.  With  the  disappear- 
ance of  sunlight  all  nature  sinks  into  a  condition  of 

repose. 

**  The  night  brings  sleep 
To  the  greenwoods  deep. 
To  the  bird  of  the  woods  its  nest ; 
To  care  soft  hours. 
To  life  new  powers. 
To  the  sick  and  the  weary — rest!  '* 

In  this  tendency  to  nightly  inaction  man  shares 
with  all  other  living  creatures.  His  body  thus  testi- 
fies to  the  intimacy  of  its  relations  with  all  portions  of 
the  solar  system.  Originated  in  the  tropical  regions 
of  the  earth,  where  day  and  night  are  nearly  equal, 
we  find  in  all  parts  of  the  world  the  same  hereditary 
need  of  a  period  of  rest,  nearly  coincident  with  the 
duration  of  the  shorter  nights  of  the  tropical  year. 
Had  the  birth-place  of  primeval  man  been  situated 
within  the  Arctic  circle,  it  is  probable  that  his  hours 
of  sleep  might  have  differed  considerably  from  the 
2 


18  INSOMNIA. 

number  now  needed  by  the  average  individual.  So 
powerful  are  the  necessities  thus  dependent  upon  the 
harmony  between  our  organization  and  the  movements 
of  the  earth,  that  if  the  habit  be  formed  of  sleeping  at 
other  hours  than  those  which  are  usually  devoted  to 
that  purpose,  the  full  complement  of  sleep  is  still  need- 
ful to  satisfy  the  demand  for  rest. 

Prominent  among  the  causes  which  predispose  to 
sleep  at  night  is  the  cessation  of  a  majority  of  the  sen- 
sations that  are  continually  pouring  in  upon  the  brain 
during  the  period  of  daylight.  Hence  the  necessity  for 
seclusion  in  darkened  rooms,  from  which  the  noises  of 
the  daytime  are  shut  out,  if  one  would  sleep  during  the 
long  days  of  the  arctic  summer,  or  if  one  would  enjoy 
a  midday  nap  at  any  season  of  the  year.  The  close 
dependence  of  wakefulness  upon  the  constant  activity 
of  the  organs  of  sensation,  is  well  illustrated  by  a  case 
related  in  Hermann's  Handbuch  der  Physiologie,  Vol. 
II,  Part  2,  p.  295.  A  young  man  had  been  reduced  by 
disease  to  such  a  condition  of  general  anaesthesia  that 
the  right  eye  and  the  left  ear  were  the  only  remaining 
paths  of  sensation  between  his  brain  and  the  external 
world.  Whenever  the  sound  eye  and  ear  were  band- 
aged so  as  to  cut  off  all  communication  with  the  brain, 
the  patient  invariably  fell  asleep  in  the  course  of  two 
or  three  minutes  after  the  interruption  of  sensation. 
In  like  manner,  some  people,  even  in  perfect  health, 
are  able  to  sleep  at  any  time  by  simply  lying  down  and 
closing  the  eyes.  Such  persons,  however,  are  not  often 
very  highly  gifted  in  the  intellectual  sphere.  They 
generally  belong  to  a  class  of  men  whose  lives  are 
laborious  and  liable  to  great  irregularity  and  fatigue. 


THE   CAUSES  OF   SLEEP.  19 

Such  people  labor  in  the  open  air,  where  every  organ 
of  sense  is  in  a  state  of  continual  excitement;  As 
soon,  therefore,  as  they  can  find  a  quiet  corner  from 
which  the  commotion  of  the  elements  is  excluded,  it  is 
only  necessary  to  close  the  eyes — the  principal  avenue 
of  communication  with  the  outside  world — and  sleep 
begins  at  once.  This  is  especially  true  if  severe  bodily 
exertion  has  preceded  the  opportunity  for  repose. 

Fatigue  of  any  sort  is  one  of  the  most  energetic 
causes  of  sleep.  The  impossibility  of  long  sustained 
exertion  is  a  fact  almost  too  familiar  to  attract  atten- 
tion. Every  muscle  must  be  suffered  to  rest  for  a 
time  after  contraction  before  it  can  be  again  con- 
tracted. Even  the  heart  and  the  muscles  of  respira- 
tion must  be  allowed  to  enjoy  regular  periods  of  repose 
many  times  each  minute.  These  are  examples  of  local 
rest,  not  involving  the  entire  body.  But  if  the  whole 
body  participate  in  any  violent  action,  every  part  will 
manifest  a  consequent  disposition  to  rest.  Witness 
the  effects  of  the  venereal  act.  Every  muscle  is 
relaxed ;  the  brain,  which  has  officiated  as  the  supreme 
source  of  energy,  experiences  exhaustion,  and  sleep 
frequently  terminates  the  voluptuous  paroxysm.  In 
like  manner,  sensations  of  severe  pain,  if  sufficiently 
prolonged,  become  a  cause  of  sleep.  Prisoners  upon 
the  rack  have  slept  through  sheer  exhaustion  while 
undergoing  the  horrors  of  torture.  Little  children 
frequently  fall  into  a  deep  sleep  immediately  after 
painful,  though  comparatively  bloodless,  surgical  op- 
erations performed  without  anaesthetics.  The  depress- 
ing emotions,  even,  may  so  fatigue  the  brain  as  to 
induce   sound   sleep  through  reaction  from  previous 


20  INSOMNIA. 

excitement.  Every  wearied  portion  of  the  body  must 
rest;  and  when  the  brain  thus  rests,  sleep  is  the  con- 
sequence. 

Impressed  by  the  force  of  such  considerations, 
certain  physiologists'  have  reasoned  from  the  analo- 
gies suggested  by  a  study  of  the  results  of  mus- 
cular fatigue,  and  have  suggested  an  hypothesis 
accounting  for  the  occurrence  of  sleep  by  a  sup- 
posed loading  of  the  cerebral  tissues  with  the  acid 
products  of  their  own  disassimilation  during  wake- 
ful activity.  The  acid  reaction  of  the  brain  and 
of  the  nerves  after  exertion,  corresponding  with  the 
development  of  acids  in  the  muscular  tissues  during 
contraction,  suggested  the  probability  that  an  excess- 
ive presence  of  lactic  acid  and  its  sodic  compounds 
might  be  the  real  cause  of  cerebral  torpor  and  sleep. 
Could  this  hypothesis  be  proved,  ordinary  sleep  would 
take  its  place  along  with  the  states  of  unconsciousness 
induced  by  anaesthetics  and  hypnotics,  and  the  lactate 
of  sodium  should  be  found  the  very  best  of  medicines 
for  the  relief  of  wakefulness.  Its  administration  for 
this  purpose,  however,  has  yielded  only  the  most  dis- 
cordant and  unsatisfactory  results.  The  fatigue  the- 
ory, moreover,  is  insufficient,  since  it  furnishes  no 
explanation  of  the  invincible  stupefaction  produced  by 
cold,  nor  does  it  render  intelligible  the  unbroken  sleep 
of  the  unborn  child. 

Far  more  comprehensive  is  the  hypothesis  advanced 

'  Obersteiner,  Zur  Theorie  des  Schlafes,  Zeitschr.  f.  Psych.  XXIX. 
Preyer,  Ueber  die  Ursachen  des  Schlafes.  Vortrag.  Stuttgart  bei  Enke. 
1877,  und  centralbl.  f.  d.  Med.  Wiss.   1875.  S.  577. 


THE   CAUSES  OF   SLEEP.  21 

by  Pfltiger.^  According  to  this  view,  the  state  of 
wakefuhiess  is  maintained  by  a  certain  degree  of 
activity  in  the  cortical  substance  of  the  brain.  Like 
all  other  bodily  organs,  this  substance  is  renovated  by 
the  assimilation  of  nutrient  materials  derived  from  the 
blood.  By  this  process  oxygen  is  stored  up  in  chem- 
ical combination,  forming  "  explosive  compounds," 
whose  precise  composition  is  not  fully  understood. 
When  for  any  reason  the  supply  of  oxygen  is  insuffi- 
cient, as  in  hemorrhage,  producing  cerebral  anaemia, 
or  in  impregnation  of  the  red  blood  corpuscles  with 
carbonic  oxide  or  chloroform,  or  other  substances  capa- 
ble of  excluding  oxygen  from  the  hemoglobin  of  the 
corpuscle,  the  cerebral  tissues  are  imperfectly  reno- 
vated. The  explosive  constituents  of  the  cortical  pro- 
toplasm are  then  inadequately  renewed  after  mental 
activity,  and  the  sensitive  portions  of  the  brain  are  no 
longer  fitted  to  manifest  the  highest  forms  of  intelli- 
gent activity.  But,  when  nothing  interferes  with 
healthy  nutrition,  the  requisite  degree  of  instability 
in  the  protoplasm  of  the  brain  is  effected  by  intussus- 
ception of  oxygen.  Under  the  influence  of  the  vari- 
ous nervous  impressions  which  reach  the  brain,  the 
unstable  protoplasmic  compounds  break  up  into 
simpler  forms.  The  motion  thus  liberated  by  these 
"  explosions "  of  excitable  matter  is,  in  some  way  at 
present  utterly  inconceivable,  projected  upon  the  field 
of  consciousness  where  the  mind  dwells ;  and  we  are 
thus  brought  into  conscious  relation  with  the  exter- 
nal world. 

That  the  capacity  for  thus   signalling   across  the 

*  Theorie  des  Schlafes.     Arch.  £.  d.  ges.   Physiol.  X,  468. 


22  INSOMNIA. 

gulf  which  divides  matter  from  mind  is  the  result  of  a 
certain  perfection  and  complexity  of  physical  structure 
is  rendered  probable  by  the  utter  failure  of  the  infra- 
cortical  organs  alone  to  impress  the  conscious  intelli- 
gence by  any  amount  of  independent  activity.  The 
same  thing  is  also  indicated  by  the  unconscious  sleep 
of  the  rudimentary  foetal  brain,  and  by  the  brevity  of 
the  intervals  of  wakefulness  which  mark  the  life  of  the 
new  born  babe.  That  this  capacity  is  dependent  upon 
a  special  mobility  of  the  atoms  of  the  brain,  is  shown 
by  the  speedy  cessation  of  intelligence  which  follows 
great  reduction  of  temperature,  as  in  hibernation,  or 
during  exposure  to  severe  frost.  That  its  exercise  is 
largely  dependent  upon  the  activity  of  the  senses  is 
proved  by  interference  with  their  function,  as  in  the 
case  above  quoted  (see  p.  18)  from  the  observations 
of  Strtimpell. 

The  dependence  of  the  waking  state  upon  the  pres- 
ence and  activity  of  a  sujficient  quantity  of  a  peculiarly 
unstable  form  of  protoplasm  in  the  brain  is  an  hypothe- 
sis which  presents  no  great  dilB&culty  of  comprehen- 
sion. But  how  may  we  explain  the  lapse  from  the 
intelligent  vivacity  of  that  waking  state  into  the  un- 
conscious inactivity  of  sleep?  I  have  elsewhere'  dis- 
cussed the  manner  in  which  artificial  sleep  is  produced 
by  impregnation  of  the  brain  with  anaesthetic  sub- 
stances that  interfere  with  sensibility,  and  finally  pro- 
duce stupefaction,  by  hindering  the  normal  processes 
of  intra-molecular  oxidation  in  the  protoplasm  of  the 
nervous  tissues.  The  same  general  line  of  argument 
may  be  extended  to  cover  the  action  of  every  narcotic 

^  Artificial  Ancesthesia  and  AncBsthetics,  pp.  15-17. 


THE  CAUSES  OF  SLEEP.  23 

agent  with  which  the  living  substance  of  the  body  may 
become  surcharged.  Accepting,  then,  the  hypothesis 
advocated  by  Obersteiner  and  Preyer,  it  becomes  an 
easy  thing  to  account  for  the  gradual  onset  of  sleep  by 
supposing  an  accumulation  of  the  "  fatigue  producing  " 
products  of  intra-molecular  oxidation.  But  we  cannot 
thus  explain  the  rapid  and,  as  it  were,  voluntary  pass- 
age from  wide  awakefulness  into  a  condition  of  deep 
sleep,  such  as  may  be  commonly  observed  among  sail- 
ors and  others  who  have  formed  the  habit  of  going  at 
once  to  sleep  at  regularly  recurring  hours  of  the  day 
or  night.  Certain  wiiters  have  endeavored  to  account 
for  this  fact  by  imagining  a  special  mechanism  at  the 
base  of  the  brain  (choroid  plexuses  of  the  fourth  ven- 
tricle, etc.,)  by  means  of  which  the  current  of  the 
blood  through  the  brain  may  be  voluntarily  dimin- 
ished, with  a  consequent  arrest  of  conscious  activity. 
But,  still  adhering  to  the  hypothesis  of  Pfltiger,  we  shall 
obtain  a  clearer  explanation  of  the  facts  by  considering 
the  phenomena  connected  with  the  succession  of  impres- 
sions upon  the  organs  of  sense.  It  has  been  ascertained* 
that  such  impressions  must  persist  for  a  certain  meas- 
urable length  of  time  in  order  to  excite  conscious  per- 
ception. A  sound  must  be  prolonged  for  at  least  f our- 
teen-hundredths  of  a  second,  a  ray  of  light  must  agitate 
the  retina  for  about  eighteen  to  twenty-hundredths  of 
a  second,  an  ordinary  contact  with  the  surface  of  the 
skin  must  continue  from  thirteen  to  eighteen-hun- 
dredths  of  a  second,  in  order  to  awaken  any  knowledge 
of  sound  and  light  and  tactile  sensation.  For  the 
simplest  act  of  perception  from  two  to  four-hundredths 

*  Carpenter's  Physiology,  8th  ed.,  p.  852. 


24  INSOMNIA. 

of  a  second  are  necessary.  It  is,  therefore,  perfectly 
reasonable  to  suppose  that  when  the  "  explosive  ma- 
terial" of  the  brain  has  been  sufficiently  "dampened" 
by  the  accumulation  of  acid  refuse  which  accompanies 
prolonged  cerebral  effort,  the  impressions  of  sense  may 
no  longer  suffice  to  excite  in  the  cortical  protoplasm 
vibrations  of  sufficient  length,  or  following  each  other 
in  sufficiently  rapid  succession,  to  sustain  conscious- 
ness. The  cortex  of  the  brain  may  then  be  likened  to 
a  body  of  water  into  which  bubbles  of  partially  soluble 
gas  are  introduced  from  below.  When  the  bubbles  are 
large,  and  when  they  follow  each  other  rapidly,  a  con- 
tinual effervescence  is  maintained  upon  the  surface  of 
the  water.  But  if  the  size  of  the  bubbles  be  reduced, 
or  if  the  solvent  capacity  of  the  liquid  be  increased, 
the  surface  will  become,  almost,  if  not  quite,  perfectly 
tranquil.  In  some  such  way,  without  any  great  dan- 
ger of  error,  may  we  picture  forth  the  manner  in  which 
the  generation  of  ideas  in  the  field  of  consciousness  is 
related  to  the  molecular  movements  in  the  space  occu- 
pied by  the  protoplasmic  substance  of  the  brain.  Re- 
turning, now,  to  the  rapid  induction  of  sleep,  we  find 
that  it  is  usually  the  experience  of  people  who  lead  an 
active  life  in  the  open  air,  and  are  compelled  to  endure 
frequent  interruption  of  their  rest.  The  sailor  who  is 
trained  to  work  four  hours  on  deck,  and  then  to  sleep 
four  hours  below,  has  been  virtually  transformed  by 
this  habit  into  a  denizen  of  a  planet  where  the  days 
and  the  nights  are  each  but  four  hours  long.  His 
bodily  functions  become  accommodated  to  this  condi- 
tion ;  his  nervous  organs  store  up  in  sleep  a  supply  of 
oxygenated  protoplasm  sufficient  only  for  an  active 


CEREBRAL  ANEMIA,  25 

period  of  four  or  five  houi's;  so  tliat,  when  the  watch 
on  deck  is  ended,  he  is  in  a  state  as  well  qualified  for 
sleep  as  a  laborer  on  shore  at  the  close  of  a  day  of 
twelve  or  fifteen  hours.  Moreover,  the  majority  of 
those  who  can  thus  easily  fall  asleep  are  individuals 
whose  waking  life  is  almost  entirely  sustained  by 
external  impressions.  So  soon,  therefore,  as  such 
excitants  are  shut  out  by  closing  the  eyes  in  a  place  of 
shelter  from  the  sounds  and  turmoil  of  the  air,  com- 
paratively little  remains  for  the  stimulation  of  ordinary 
consciousness,  and  sleep  readily  supervenes  through 
mere  lack  of  cerebral  excitement,  especially  if  the 
excitable  matter  of  the  brain  has  been  previously  over- 
whelmed by  the  products  of  active  exertion. 

That  analogous,  though  not  identical,  predisposi- 
tion to  unconsciousness  may  also  be  rapidly  induced 
by  modifications  of  the  cerebral  circulation  is  proved 
by  the  sudden  reduction  of  cerebral  excitability  and 
consciousness  which  occurs  during  the  act  of  fainting. 
In  this  counterfeit  presentment  of  sleep  the  important 
part  played  by  variations  of  the  blood  current  through 
the  brain  is  so  conspicuous  that  certain  writers  have 
attempted  to  show  that  genuine  sleep  is  the  result  of  a 
diminution  in  the  flow  of  blood  to  the  cortex  of  the 
brain.  An  ingenious  physician  has  even  attempted  to 
relieve  insomnia  very  much  as  a  surgeon  might  under- 
take to  cure  a  popliteal  aneurism — ^by  placing  tourni- 
quets on  the  arteries  leading  to  the  afPected  part.  But 
the  mere  fact  that  syncope  produces  unconsciousness 
does  not  prove  that  "cerebral  anaemia"  should  be 
elevated  to  the  rank  of  the  principal  cause  of  natural 
sleep.      The  nervous  process  is  the  primary  factor. 


26  INSOMNIA. 

The  circulation  of  the  blood  is  everywhere  under  the 
immediate  control  of  the  nervous  system.  Conse- 
quently, every  change  in  the  condition  of  the  nervous 
structures  is  followed  by  a  corresponding  change  in 
the  state  of  the  circulating  apparatus.  Wherever  an 
organ  is  aroused  to  activity,  so  delicate  are  the  adjust- 
ments by  which  it  is  connected  with  the  brain  and  with 
the  heart  that  it  is  at  once  irrigated  by  an  increased 
flow  of  blood.  When  its  functional  activity  subsides, 
the  same  mechanism  provides  for  a  corresponding 
reduction  in  the  supply  of  blood  to  its  tissues.  The 
brain  itself  forms  no  exception  to  this  law.  This  has 
been  admirably  shown  by  the  observations  of  Professor 
Mosso,  of  Turin.'  The  learned  professor  enjoyed  the 
rare  opportunity  of  observing  three  individuals  who 
had  suffered  the  loss  of  a  considerable  portion  of  the 
bony  walls  of  the  cranium,  exposing  the  surface  of  the 
cerebrum,  and  affording  a  view  of  the  pulsation  of  the 
vessels  of  the  brain.  With  the  aid  of  the  cardiograph, 
the  sphygmograph,  the  hydrosphygmograph,  and  the 
plethosphygmograph,  it  became  possible  to  register 
the  circulation  of  the  blood  in  the  brain,  and  to  com- 
pare that  portion  of  its  course  with  the  coincident  cir- 
culation in  other  parts  of  the  body.  It  was  thus  shown 
that  every  increase  of  emotional  or  intellectual  activity 
was  attended  by  an  increase  in  the  activity  of  the  cere- 
bral circulation.  This  increase  was  procured  at  the 
expense  of  other  portions  of  the  body,  which  exhibited 
a  coincident  reduction  in  the  amount  of  blood  received 
from  the   heart.     The  occurrence  of   sleep  caused  a 

'  Sulla  Circolazione  del  Sangue  nel  Cervello  dell '  Uomo.      Abstract  in 
Brain,  Vol.  IV,  p.  loo. 


CEREBRAL   CIRCULATION  IN  SLEEP.  27 

diminution  in  the  number  of  respirations,  and  a  fall 
of  six  or  eight  beats  in  the  pulse.  The  volume  of  the 
brain  and  its  temjDerature  were  at  the  same  time  slightly 
reduced,  through  the  diversion  of  blood  from  the  head 
to  other  regions  of  the  body.  The  consequent  dilatation 
of  the  vessels  in  the  extremities  was  readily  demon- 
strated by  the  use  of  the  plethosphygmograph.  The 
extreme  sensitiveness  of  the  nervous  centers  was  fur- 
ther illustrated  by  the  fact  that  if,  during  sleep,  a  ray 
of  light  were  directed  upon  the  eyelids,  or  if  any  organ 
of  sense  were  moderately  excited  without  waking  the 
patient,  his  respiration  was  at  once  accelerated;  the 
heart  began  to  beat  more  rapidly,  the  vessels  of  the 
extremities  contracted,  and  the  blood  flowed  more 
freely  into  the  brain.  Similar  results  accompanied  the 
act  of  dreaming.  The  return  of  full  consciousness  on 
waking  was  followed  by  an  immediate  increase  in  the 
activity  of  the  intra-cranial  circulation. 

The  extreme  susceptibility  of  the  brain  to  influences 
proceeding  from  artificial  disturbances  in  the  circula- 
tion, was  exhibited  in  the  case  of  one  of  Professor 
Mosso's  patients.  By  compression  of  the  carotid 
arteries,  unconsciousness  was  induced,  and  an  attack 
of  convulsions  was  aroused.  In  no  other  part  of  the 
body  can  a  corresponding  disturbance  of  function  be 
so  quickly  produced  by  similar  means.  A  limb  may 
be  rendered  bloodless  for  nearly  half  an  hour,  by  the 
application  of  an  elastic  bandage,  and  yet  its  sensory 
nerves  will  remain  capable  of  transmitting  impressions 
from  the  periphery.  But  in  this  case,  compression  of 
the  carotids  for  only  eight  seconds  was  sufficient  to 


28  INSOMNIA. 

abolish  consciousness  and  to  excite  convulsive  move- 
ments. 

In  all  such  observations  it  is  worthy  of  note  that 
the  nervous  impression  is  the  primary  event  so  long 
as  artificial  disturbances  are  not  intruded.  The 
changes, of  blood-pressure  and  circulation  were  inva- 
riably secondary  to  the  excitement  of  nerve  tissue. 
Sleep,  therefore,  must  be  regarded  as  the  cause,  rather 
than  the  consequence,  of  the  so-called  cerebral  anae- 
mia which  obtains  in  the  substance  of  the  brain  during 
repose.  This  condition  of  "anaemia"  is  nothing  more 
than  the  relatively  lower  state  of  circulation  which 
may  be  remarked  in  every  organ  of  the  body  during 
periods  of  inactivity.  Every  impression  upon  the  sen- 
sory structures  of  the  brain  occasions  a  corresponding 
liberation  of  motion  in  those  structures.  The  move- 
ment thus  initiated  arouses  the  vaso-dilator  nerves  of  the 
cerebral  vessels  and  excites  the  vaso-constrictor  nerves 
of  all  other  portions  of  the  vascular  apparatus.  Hence 
the  superior  vascularity  of  the  brain  so  long  as  the 
organs  of  sense  are  'fresh  and  receptive.  Hence  the 
diminishing  and  varying  vascularity  of  the  different 
departments  of  the  brain  as  sleep  becomes  more  or 
less  profound.  These  modifications  of  the  brain  and 
of  its  circulation  are  well  illustrated  by  the  effects  of  a 
moderate  degree  of  cold  applied  to  the  cutaneous  nerves 
of  the  body,  as  not  unfrequently  happens  when  the 
night  grows  cool  towards  morning.  The  disturbance 
of  the  sensitive  nerves  of  the  skin  is  transmitted  to 
the  brain.  The  excitement  of  this  organ  causes  dilata- 
tion of  its  vessels,  and  increased  irritability  of  the  cor- 
tical  instrument   of   perception.       This   becomes  the 


THE  CAUSE  OF  SLEEP.  29 

starting  point  for  the  projection  of  impulses  upon  the 
field  of  consciousness,  producing  dreams,  or  even  a 
complete  awakening  from  sleep. 

The  cause  of  sleep  must,  therefore,  be  sought  in 
the  molecular  structure  of  the  brain,  rather  than  in 
fluctuations  of  the  blood-current.  In  the  present  state 
of  our  knowledge  it  must  be  negatively  represented  as 
the  consequence  of  a  deficiency  in  the  amount  of  mov- 
able oxygen  in  the  nervous  tissue.  This  deficiency 
may  be  the  result  of  immaturity,  as  in  the  foetus,  or  in 
the  new-born  infant ;  or  it  may  result  from  the  accumu- 
lation of  an  excess  of  the  waste-products  of  intra- 
molecular oxidation  during  functional  activity — prod- 
ucts which  hinder  the  further  passage  of  oxygen  into 
stable  combination  with  the  oxidizable  elements  of 
protoplasm.  Sleep  thus  produced  differs  from  the 
artificial  sleep  induced  by  narcotic  drugs,  in  the  fact 
that  its  cause  is  self -generated  by  the  instrument  of 
thought,  while  narcotic  stupor  is  caused  by  the  intru- 
sion of  substances  derived  from  without — substances 
which,  like  the  natural  refuse  of  the  living  cells,  more 
or  less  completely  hinder  the  processes  of  oxygena- 
tion and  oxidation  within  the  tissues  of  the  body. 
Hence  the  states  of  healthy  sleeping  and  waking  must 
necessarily  be  self -limited  and  regularly  successive; 
while  the  state  of  narcotism  is  purely  accidental,  and 
its  duration  exactly  corresponds  with  the  variable 
length  of  the  period  during  which  the  body  may  re- 
main impregnated  with  the  hypnotic  agent. 

Certain  morbid  forms  of  sleep  further  illustrate  its 
dependence  upon  the  persistence  of  depression  in  the 
functional  activity  of  the  brain.     For   some  persons 


30  INSOMNIA. 

this  seems  to  constitute  their  normal  condition.  They 
are  either  excessively  fat,  red-faced,  and  soaked  with 
beer,  or  they  are  pale,  anaemic,  and  pnlpy,  with  flabby 
muscles  and  a  feeble  circulation.  They  fall  asleep 
whenever  left  to  themselves,  and  never  seem  to  be 
fully  aroused  to  active  life.  The  fat  boy  who  figures 
so  amusingly  in  The  Pickwick  Papers,  furnishes  a 
life-like  picture  of  this  variety  of  somnolence. 

The  introductory  stage  of  the  eruptive  fevers  is 
often  characterized  by  somnolence.  It  also  frequently 
appears  as  the  forerunner  of  coma  in  the  various  dis- 
eases which  terminate  in  unconsciousness  and  death. 
A  singular  example  of  this  has  been  observed  among 
the  negro  inhabitants  of  the  Atlantic  coast  of  tropical 
Africa.  The  disorder  is  known  to  English  writers  as 
sleeping  dropsy;  by  the  French  it  is  called  maladie  die 
sommeil.  It  is  characterized  by  daily  paroxysms  of 
somnolence  which  tend  to  become  more  and  more  con- 
tinuous and  profound  until  they  are  finally  merged  in 
fatal  coma.  For  our  knowledge  of  the  disease  we  are 
chiefly  indebted  to  the  description  by  Clark,'  an  Eng- 
lish surgeon  who  practised  in  Sierra  Leone,  and  to 
the  monograph  by  Guerin,^  a  French  naval  surgeon, 
who  had  enjoyed  exceptional  opportunities  for  observa- 
tion among  the  laborers  who  had  been  carried  from 
Africa  to  the  island  of  Martinique.  Similar  cases  have 
been  occasionally  reported  in  other  regions  of  the 
world,  but  it  is  among  the  Africans  that  it  has  been 
principally  remarked.     The    onset  of   the   malady  is 

^Transactions  of  the  London  Epidemiological  Society^  Vol.  I,  p.  ii6. 
"*  De  la  maladie  du  sommeil,    1869. 


MALADIE  DU  SOMMEIL.  31 

gradual,  commencing  with  a  slight  frontal  neadache. 
After  a  few  days  a  disposition  to  sleep  after  meals  is 
noted.      This  becomes   increasingly   urgent,   and  the 
intervals  of  sleep  are  prolonged  until  at  length  the 
patient   becomes    continually   soperose.     The  waking 
periods  are  marked  by  a  sluggish  state  of  the  intel- 
lectual faculties.     The  pulse  is  not  accelerated,  and  it 
remains  full  and  soft.     The  veins  of  the  sclerotic  are 
turgid,  and  the   eyeball  seems  unusually  prominent. 
The  temperature  does  not  increase,  but  rather  tends  to 
diminish  its  figure.     The  skin  is  dry  and  moderately 
cool.     The  tongue  continues  moist,  and  is  covered  with 
a  white  fur.     The  bowels  and  the  bladder  are  regularly 
emptied,  and  the  appetite  persists  with   considerable 
vigor.     Finally,  the  patient  becomes  completely  coma- 
tose, and  dies  quietly.     Sometimes,  however,  the  evo- 
lution of  the  disease  is  less  tranquil.     Epileptiform 
convulsions,     followed     by    progressively    deepening 
periods  of  coma,  interrupt  its  course,  and  a  continuous 
muscular  agitation  marks  the  closing  scene.     At  the 
same  time  the  pulse  grows  weaker  and  more  frequent 
until   its    movements    cease   in   death.     Recovery   is 
almost  unknown,  though  the  duration  of  the  disease 
often  varies  from  three  months  to  a  year  or  longer. 
Examination  of  the  body  after  death  yields  very  nega- 
tive results ;  the  sinuses  and  larger  vessels  of  the  brain 
are  engorged  with  blood,  but  no  evidence  of  inflam- 
mation is  anywhere  apparent.     The  other  organs  pre- 
sent  no    pathological    alterations    whatever.       These 
observations  seem  to  indicate  that  the  disease  origi- 
nates in  some  form  of  general  blood-poisoning,  rather 
than  in  any  local  inflammation  or  degeneration.     Dr. 


32  INSOMNIA. 

Clark  has  called  attention  to  an  enlargement  of  the 
cervical  glands  as  a  feature  of  the  malady.  According 
to  Dr.  G.  H.  Bachelder/  the  native  physicians  cure 
the  disease  by  extirpation  of  the  affected  glands.  He 
has  also  observed  an  initial  lesion  in  the  nasal  mucous 
membrane.  If  this  be  confirmed,  the  malady  will  take 
its  place  among  the  forms  of  somnolence  produced  by 
infection  of  the  blood. 

Between  the  profound  unconsciousness  of  natural 
sleep  and  coma  may  be  placed  the  distinction  that  the 
one  is  always  the  consequence  of  healthy  physiological 
processes,  while  the  other  is  always  the  result  either  of 
injury,  of  disease,  or  of  some  form  of  intoxication. 
Comatose  unconsciousness  may  be  the  result  of  cerebral 
compression  caused  by  injury  of  the  head,  or  by  the 
presence  of  an  inflammatory  exudation.  Intra-cranial 
tumors,  embolisms,  thrombi,  diseases  of  the  cerebral 
arteries,  and  degenerations  of  the  brain, — in  short, 
every  morbid  change  of  which  the  liquids  and  the 
Bolids  within  the  cranium  are  capable — may  become 
the  cause  of  coma.  Toxaemic  conditions  of  the  cir- 
culating fluids  of  the  body  may  benumb  the  brain  with 
comatose  sleep.  Few  diseases,  therefore,  exist  without 
the  possibility  of  coma  as  one  of  their  consequences — 
a  coma  which,  however,  must  not  be  confounded  with 
the  genuine  sleep  which  sometimes  occupies  the  larger 
part  of  convalescence  from  acute  illness.  During  such 
convalescence  there  is  a  reversion  to  the  infantile  type 
of  nutrition  with  all  its  need  of  prolonged  and  fre- 
quent periods  of  repose.  Like  normal  sleep,  the  coma- 
tose condition  admits  considerable  variation  of  inten- 

*  T^  Medical  Record,  July  i,  1882,  p.  23. 


LETHARGY.  33 

sity.  The  patient  may  sometimes  be  partially  roused, 
as  from  the  coma  of  alcoholic  intoxication,  and  he  may 
finally  recover  complete  consciousness ;  but  very  often 
the  reverse  is  the  fact.  The  coma  deepens  into 
paralysis  of  the  respiratory  centres,  and  death  con- 
cludes existence  without  the  slightest  manifestation  of 
sensibility  or  intelligence. 

Lethargy  is  a  pathological  variety  of  sleep,  in  which 
the  repose  of  the  body  is  even  more  complete  than  in 
coma.  The  victim  of  coma  often  presents  a  counte- 
nance suffused  with  blood;  the  pulse  beats  vigorously, 
and  respiration  may  become  stertorous.  But  in  lethargy 
the  abolition  of  bodily  movement  is  almost  absolute. 
In  the  milder  forms  of  this  disorder  the  patient  may 
be  partially  roused,  so  as  to  attempt  an  answer  when 
addressed,  appearing  like  a  person  in  very  deep  sleep; 
but  in  the  majority  of  cases  he  remains  insensible, 
unconscious,  and  utterly  irresponsive  to  ordinary  forms 
of  irritation.  Respiration  and  circulation  are  reduced 
to  a  minimum,  and  may,  even  for  a  time,  become  im- 
perceptible. Uncomplicated  with  hysteria,  the '  dis- 
order is  rapidly  fatal,  but,  according  to  Rosenthal,' 
hysterical  lethargy  is  never  mortal. 

Many  examples  of  this  disease  have  been  afforded 
by  the  records  of  apparent  death.  I  am  well  acquainted 
with  a  lady  who,  in  early  childhood,  had  been  laid  out 
for  burial  at  the  supposed  termination  of  some  infant- 
ile illness.  Her  mother  alone  insisted  that  the  child 
was  still  alive.  After  some  time  spent  in  weeping  and 
expostulation,  she  applied  a  blister  to  the  thorax  of 
the  babe.     This  soon  excited  evidences  of  painful  irri- 

^  Real.  Encyc.  der ges.  Heilkunde^  VIII,  276. 
3 


34  INSOMNIA. 

tation,  followed  by  a  complete  recovery.  Still  more 
instructive  is  the  case,  narrated  by  Rosenthal/  of  a 
young  woman,  twenty-four  years  of  age,  who,  in  con- 
sequence of  violent  emotional  excitement,  became 
unconscious,  and  presented  no  signs  of  life,  though 
tested  by  placing  a  mirror  before  the  mouth,  and  by 
dropping  melted  sealing-wax  upon  the  skin.  On  rais- 
ing her  eyelids,  the  pupils  gave  no  reaction  to  light; 
the  limbs  remained  perfectly  flaccid,  and  the  radial 
arteries  were  pulseless.  Careful  auscultation,  how- 
ever, detected  a  very  feeble  and  intermittent  sound  in 
the  cardiac  region.  The  walls  of  the  chest  exhibited 
no  movement,  but  the  lateral  surfaces  of  the  abdomen 
presented  a  slow  and  almost  imperceptible  oscillation. 
Gentle  faradization  of  the  muscles  and  nerves  of  the 
face,  arm,  and  hand,  excited  definite  muscular  contrac- 
tions. By  this  method  Rosenthal  became  satisfied 
that,  although  the  patient  had  remained  for  thirty-two 
hours  in  this  condition,  she  was  only  apparently  dead. 
In  fact,  after  continuing  forty-four  hours  in  a  state  of 
suspended  animation,  she  awoke  spontaneously,  made 
a  rapid  recovery,  and  seemed  to  enjoy  as  comfortable 
health  as  an  excitable,  nervous  temperament  would 
permit. 

Certain  authors  make  a  distinction  between  lethargy 
and  apparent  death ;  but  the  difference  is  one  of  degree 
rather  than  of  kind.  The  movements  of  respiration 
and  of  circulation,  though  greatly  enfeebled,  are  read- 
ily observed  in  ordinary  forms  of  lethargy;  but  in 
apparent  death  the  pulse  can  no  longer  be  discovered, 
and  nothing  more  than  the  faintest  sound  can  be  dis- 

^Op.  cit,  p.  276. 


LUCID  LETHARGY.  35 

tinguished  in  the  region  of  the  heart.  It,  therefore, 
becomes  important  to  have  within  reach  a  crucial  test 
of  the  persistence  of  general  vitality.  Such  evidence, 
according  to  Rosenthal,  is  furnished  by  the  faradaic 
current.  Within  two  or  three  hours  after  actual  death, 
the  muscles  cease  to  respond  to  the  induced  current ; 
but  in  apparent  death  this  form  of  electro-muscular 
contractility  never  disappears.  Every  other  test  that 
has  been  proposed  has  failed  under  certain  circum- 
stances. Observation  of  the  changes  in  muscular  tem- 
perature during  electrical  excitation  is  a  method  better 
adapted  to  the  laboratory  than  for  clinical  practice. 

Lucid  lethargy. —  In  certain  cases  of  apparent 
death  the  patient  exhibits  all  the  external  appearance 
of  suspended  animation,  but  the  power  of  conscious 
perception  does  not  cease.  The  senses  of  sight  and 
hearing  remain,  and  are,  perhaps,  intensified  by  inhi- 
bition of  the  power  of  voluntary  movement.  The 
sufferer  sees  and  hears ;  perception,  emotion,  memory, 
the  power  of  reasoning,  judgment,  volition,  all  persist. 
Only  the  power  of  executing  voluntary  movements  is 
lacking. 

The  victims  of  this  variety  of  apparent  death  are 
usually  women,  or  men  who  are  characterized  by  a 
feminine  nervous  organization.  Great  mental  excite- 
ment, fatigue,  semi-starvation,  and  exhausting  diseases, 
are  the  principal  exciting  causes  of  the  event.  The 
following  case,  related  by  my  friend.  Dr.  P.  S.  Hayes, 
of  Chicago,  illustrates  the  phenomena  of  lucid  leth- 
argy. The  patient  was  a  female  physician,  about 
thirty  years  of  age,  unmarried,  and  consumptively 
inclined.     During  the  course  of  a  long  and  wearisome 


36  INSOMNIA. 

hospital  service,  she  was  prostrated  with  typhoid  fever. 
Placing  herself  under  the  immediate  care  of  my  inform- 
ant, she  was  also  attended  by  several  of  the  most  emi- 
nent physicians  in  the  city.     After  a  long  and  exhaust- 
ing illness  she  appeared  to  be  dying.     In  the  presence 
of  her  physician,  and  surrounded  by  her  relatives,  she 
ceased  to  breathe.     The  pulse  stopped,  life  seemed  to 
have  gone  out.     Bottles  of  hot  water  were  applied  to 
the  limbs,  and  various    restoratives   were    employed. 
After  a  considerable  time  she  began  again  to  breathe, 
and  a  gradual  recovery  followed.     During  the  whole 
time  of  apparent  death,  consciousness  had  been  pre- 
served.    She  seemed  to  be  looking  down  from  a  point 
above  her  bed ;  she  could  see  the  doctor  feeling  for  her 
pulse,  and  was  grieved  by  the  sorrow  of  her   friends. 
Ordinary  sensation  was  temporarily   suspended,   and 
she  could  not  distinguish  the  contact  of  the  hot- water 
bottles  that  were  applied  to  her  limbs,  though  actually 
scalded   by  their    excessive    heat.      Borne    upon    the 
wings  of  an  excited  imagination,  she  thought  herself 
permitted  to  look  into  heaven,  but  was  not  suffered  to 
enter  its  gates.     In  this  exaltation  of  the  imagination 
the  reasoning  faculties  also  shared,    so    that    certain 
philosophical  problems  which  had  previously  baffled 
her    intellect    were    now    perfectly    comprehensible, 
and   the    memory   of   their    solution    persisted    after 
recovery. 

Many  similar  narratives  have  been  duly  authenti- 
cated, but  the  limits  of  the  present  chapter  will  not 
permit  a  discussion  which  properly  belongs  to  an 
investigation  of  the  phenomena  of  trance.  The  im- 
portant fact  for  present  consideration  is  the  persist- 


LUCID   LETHARGY.  37 

ence  of  conscious  life,  despite  the  appearance  of  death. 
In  this  preservation  of  consciousness,  notwithstanding 
the  temporary  suspension  of  certain  kinds  of  sensibil- 
ity and  the  power  of  voluntary  motion,  may  be  discov- 
ered a  relationship  between  the  phenomena  of  lucid 
lethargy  and  various  disturbances  of  sleep,  which  will 
be  considered  in  a  succeeding  chapter. 


CHAPTER  IL 

INSOMNIA,  OR  WAKEFULNESS. 

Sleep,  gentle  sleep, 
Nature's  soft  nurse,  how  have  I  frighted  thee 
That  thou  no  more  wilt  weigh  mine  eyelids  down 
And  steep  my  senses  in  forgetfulness? 

— King  Henkt  IV,  Second  Part. 

We  have  seen  that  the  condition  of  normal  sleep  is 
determined  by  a  peculiar  molecular  state  of  the  sub- 
stance of  the  brain — a  modification  regularly  alternat- 
ing with  that  by  means  of  which  the  condition  of 
wakefulness  is  sustained.  We  have  also  seen  that 
sleep  is  liable  to  variations  in  its  intensity,  and  that  its 
course  may  be  partially  interrupted  by  dreams,  or  even 
by  a  more  or  less  complete  resumption  of  the  move- 
ments of  locomotion,  constituting  the  different  varieties 
of  somnambulism.  Our  attention  must  now  be  directed 
to  the  consideration  of  those  greater  disturbances  of 
sleep  which  either  serve  to  prevent  its  full  develop- 
ment, or  else  to  actually  interrupt  its  course,  rendering 
it  incomplete  and  fragmentary,  or  even  abolishing  it 
altogether.  But,  inasmuch  as  the  healthy  brain,  when 
associated  with  a  healthy  body,  can  only  by  an  extra- 
ordinary effort  of  the  will  be  kept  awake  beyond  a  cer- 
tain period,  and  then  only  for  a  short  time  beyond  the 
ordinary  interval  of  wakefulness,  it  follows  that  the 
study  of  the  usual  causes  of  insomnia  must  be  an  in- 

(38) 


CAUSES   OF  INSOMNIA.  39 

vestigation  of  morbid  conditions  of  the  bodily  func- 
tions. Sleeplessness,  therefore,  must  result,  1st,  from 
a  disturbance  of  the  peripheral  sensory  organs  of  the 
nervous  system;  2nd,  from  disordered  conditions  of 
the  sensory  nerves  and  nerve  tracts ;  3rd,  from  morbid 
states  of  the  brain;  4th,  from  any  or  all  of  these  con- 
ditions operating  in  association  with  each  other.  We 
may,  therefore,  consider,  I,  Insomnia  caused  hy  irrita- 
tion of  the  peripheral  portions  of  the  sensory  apparatus; 
and,  II,  Insomnia  caused  hy  morbid  states  of  the  central 
nervous  organs. 

I.  Insomnia  caused  by  irritation  of  the  peri- 
pheral PORTIONS  OF  THE  SENSORY  APPARATUS. 

Irritation  of  the  sensory  apparatus  may  be  ranked 
in  three  classes: 

1.  Affections  of  the  organs  of  special  sense. 

2.  Affections  of  the  nerves  of  common  sensation. 

3.  Affections  of  the  sympathetic  nerves. 

1.  Affections  of  the  organs  of  special  sense. — Promi- 
nent among  these  is  the  effect  of  light  upon  the  eye. 
The  darkness  of  night  favors  sleep ;  the  presence  of 
light  hinders  its  incidence  and  renders  it  less  pro- 
found. During  the  gloom  of  a  total  eclipse  animals 
seek  their  shelter ;  birds  hide  themselves  in  their  nests ; 
domestic  fowls  arrange  themselves  upon  the  roost,  and 
seem  quite  disconcerted  by  the  speedy  return  of  sun- 
light. Children  often  find  it  difficult  to  sleep  in  an 
illuminated  room.  I  have  known  nurses  who  would 
sit  with  a  wakeful  infant  under  a  powerful  gaslight  till 
after  midnight,  and  then  would  express  their  surprise 
that  the  baby  persisted  in  gazing  at  the  flame  instead 
of  going  quietly  to  sleep.     The  inhabitants  of  North- 


40  INSOMNIA. 

ern  Europe  find  it  necessary  to  darken  their  sleeping 
rooms  during  the  long  polar  day ;  and  travelers  in  such 
regions  often  suffer  for  want  of  the  natural  sleep  which 
only  darkness  affords.  Judge  Caton,  writing  of  his 
travels  in  Norway'  says:  "We  longed  for  darkness 
and  for  night.  Do  what  we  could  to  darken  the  win- 
dows to  keep  out  the  light,  still  it  was  not  night  as 
nature  makes  it,  and  which  the  habit  of  a  lifetime  had 
rendered  necessary  to  sound  repose.  Artificial  dark- 
ness, especially  when  incomplete,  is  as  far  from  night 
as  artificial  light  is  from  day.  .  .  .  These  sunny 
nights  can  hardly  conduce  to  health,  they  steal  away 
so  much  of  sleep.  One  does  not  readily  get  sleepy  in 
the  sunshine,  and  then  we  are  so  apt  to  forget  to  look 
at  the  watch  to  see  if  it  is  time  to  retire." 

In  the  tropical  regions  of  the  world  it  is  usual  for 
the  inhabitants  to  sleep  during  the  middle  of  the  day; 
but  they  take  great  pains  to  exclude  the  light  from 
their  houses  during  the  hours  of  sleep.  The  Pacific 
Islanders  cover  their  faces  with  the  bed  clothes  for  the 
purpose  of  excluding  the  light  while  attempting  to 
sleep.  Repose  thus  obtained  in  the  daytime  often 
serves  to  convert  the  night  into  a  season  of  wakeful- 
ness. The  Africans  sleep  and  dream  away  the  heated 
hours  of  the  day,  and  give  up  considerable  portions  of 
the  night  to  festivity  in  the  open  air — a  practice  which 
undoubtedly  contributes  to  the  permanence  of  an  in- 
ferior grade  of  social  life. 

Sudden  illumination  of  the  sleeping  room  will  fre- 
quently awaken  the  sleeper.  During  the  great  fire  in 
Chicago,  A.  D.  1871,  many  persons  were  thus  aroused 

M  Summer  in  Norway,  by  John  Dean  Caton,  pp.  251  and  311. 


EFFECTS  OF  NOISE.  4=1 

from  their  slumbers  as  the  flames  lighted  up  the  streets 
adjoining  their  houses.  One  of  my  acquaintances  was 
awakened  one  night  by  a  flash  of  light  from  the  lan- 
tern of  a  burglar  who  was  moving  noiselessly  about 
her  chamber.  The  experience  of  almost  every  one  will 
testify  to  the  effects  of  sheet-lightning  silently  illumi- 
nating the  sky  by  night.  Dreams,  also,  are  not  unfre- 
quently  excited  by  the  incidence  of  light  upon  the 
closed  eyelids.^ 

The  sense  of  hearing  is  one  of  the  most  persistent 
of  the  special  senses  during  the  incidence  of  sleep.  It 
is  perhaps  the  most  excitable  of  these  senses  during 
the  period  of  repose.  Long  after  the  subject  has  be- 
come immersed  in  sleep  his  auditory  apparatus  remains 
sensitive  to  sounds.  Dreams  are  often  produced  by 
impressions  upon  the  ear.  Often  in  sleep  it  seems  as 
if  the  sense  of  hearing  remained  wakeful  and  watchful 
for  expected  signals,  as  when  an  alarm  clock  serves  to 
arouse  the  sleeper  at  an  appointed  hour.  Sometimes 
the  sleeper  may  be  shaken  and  tumbled  about  in  his 
bed  without  waking,  but  if  he  be  addressed  by  name 
he  will  usually  reply.  It  is  scarcely  probable  that  the 
auditory  apparatus  is  any  more  wakeful  than  other 
portions  of  the  nervous  system,  but  its  external  por- 
tions remain  during  sleep  more  completely  exposed 
and  adapted  to  the  reception  of  impressions  than  is 
possible  for  the  eye  and  for  the  organs  of  touch  and 
taste. 

The  persistent  sensitiveness  of  the  ear  during 
sleep  is  not  so  much  a  capacity  for  noticing  sounds 
as  a  sensibility  to  variations  in  sonorous  impressions. 

^  A.  Maury,  op.  cit.,  p.  156. 


42  INSOMNIA. 

Thus  a  steady  and  monotonous  noise  may,  if  long  con- 
tinued, serve  to  render  one  sleepy;  but  the  sudden 
cessation  of  the  same  sound  will  awaken  every  one. 
Slowly  lulled  to  sleep  by  the  incessant  rumble  of  the 
engine  upon  one  of  the  old-fashioned  Long  Island 
Sound  steamboats,  how  immediate  the  awakening  of  a 
whole  cabin  full  of  people,  when  the  wheels  were  sud- 
denly stopped!  A  recent  traveler  in  Guiana'  relates 
a  curious  experience  with  an  Indian  magician  who  un- 
dertook to  cure  him  of  a  slight  headache  and  fever. 
The  method  of  cure  consisted  in  placing  the  patient  at 
night  in  his  hammock,  while  the  magician  kept  up  a 
hideous  succession  of  yells  and  shouts,  shaking  the 
walls  and  roof  of  the  house  with  an  uproar  which  never 
ceased  for  six  hours.  Before  long  the  patient  passed 
into  a  kind  of  fitful  sleep  or  stupor,  during  which  he 
seemed  to  be  suspended  in  a  surging  ocean  of  sound. 
When  the  noise  died  away,  as  if  growing  fainter  in 
the  distance,  he  would  rouse  up  into  a  semi-conscious 
state,  but  when  it  again  increased  he  would  fall  back 
into  stupor.  At  last,  when  the  noise  finally  ceased,  he 
awoke  completely,  but  without  the  slightest  relief 
from  headache  —  an  experience  quite  illustrative  of 
the  manner  in  which  the  brain  may  be  affected  by 
sound. 

It  is  not  often  that  the  sense  of  smell  becomes  the 
avenue  of  impressions  that  interfere  with  sleep.  So 
different  are  the  capacities  of  individuals  in  this  par- 
ticular that  an  odor  which  might  severely  annoy  one 
person,  would  pass  almost  unnoticed  by  another. 
Large  cities  are  sometimes  invaded  by  overwhelming 

^  Among  the  Indians  of  Guiana.     By  Everard  F.  Tm  Thurn. 


EFFECT   OF   ODORS,    SAVORS,    AND   HEAT.  43 

stenches  from  the  various  factories  which  spring  up  in 
their  neighborhood.  While  it  is  seldom  true  that  the 
vapors  discharged  by  such  establishments  are  directly- 
deleterious  to  health,  they  may  become  indirectly  a 
cause  of  ill-health  through  the  wakefulness  occasioned 
by  them  among  weakly  invalids.  The  smell  of  smoke 
in  a  bed-chamber  sometimes  serves  to  awaken  a  sleeper, 
giving  warning  of  the  outbreak  of  a  fire  in  the  build- 
ing. Less  energetic  odors  may  disturb  the  depth  of 
sleep  without  actually  waking  the  patient.  Thus 
Maury  records^  that  when  he  was  made  to  inhale  the 
vapor  of  cologne  water  while  asleep,  he  dreamed  of  be- 
ing in  the  shop  of  a  perfumer. 

Excitement  of  the  sense  of  taste  would,  doubtless, 
operate  in  a  similar  manner;  but  it  is  so  difficult  to 
arouse  this  sense  without  at  the  same  time  irritatinsr 
the  nerves  of  common  sensation  about  the  mouth,  that 
very  little  can  be  said  regarding  the  matter.  Dreams 
of  gustatory  sensations  are  usually  of  subjective 
origin,  dependent  upon  some  reflex  movement,  or 
upon  some  agitation  of  the  organ  of  memory,  within 
the  brain. 

If,  with  Sir  William  Thompson,^  we  recognize  a 
sixth  sense — ^the  sense  of  temperature — it  must  be  ad- 
mitted that  through  the  varying  sensations  of  heat  and 
cold,  sleep  can  be  greatly  disturbed.  Every  one  will 
recall  to  mind  the  story  told  by  Dugald  Stewart,  of  a 
gentleman  who  dreamed  of  walking  over  heated  lava 
on  Mt.  ^tna  when  a  bottle  of  hot  water  was  placed 
against  his  feet,   in  bed,  on  account  of  some   slight 

*  Le  Sommeil  et  les  Reves,  p.  154. 
^  .Vature,  Vol.  XXIX,  pp.  438-462. 


44  INSOMNIA. 

indisposition.  The  temperature  of  the  air  is  one  of 
the  most  important  factors  in  the  determination  of 
sleep.  A  high  temperature  keeps  every  one  awake — 
a  fact  well  known  among  the  unfortunate  denizens  of 
the  garrets  in  our  great  cities.  Not  only  is  wakeful- 
ness the  direct  result  of  heat,  but  it  is  aggravated  and 
embittered  by  the  accompaniments  of  a  torrid  climate 
— insects,  foul  air,  and  cutaneous  disorders.  In  the 
East  Indies,  so  difficult  is  sleep  under  such  conditions 
that  the  wealthy  inhabitants  compel  their  servants  to 
cool  them  all  night  with  the  punkah,  a  large,  swinging 
fan,  suspended  above  the  bed,  and  kept  in  motion  by 
means  of  a  cord  leading  outside  of  the  bed-room  to  the 
verandah,  where  the  punkali-ivallah  sits  and  pulls  the 
string  while  his  master  sleeps.  So  powerful  is  the 
force  of  habit  in  the  organization  of  the  automatic  ap- 
paratus of  the  body  that,  though  these  punkah-pullers 
often  fall  asleep,  they  still  continue,  without  interrup- 
tion, the  successive  movements  by  which  the  fan  is 
kept  in  operation. 

The  evil  effects  of  a  high  temperature  are  greatly 
aggravated  by  the  presence  of  humidity  in  the  atmos- 
phere. Dampness  interferes  with  the  process  of  ex- 
halation from  the  surface  of  the  body,  which,  conse- 
quently, tends  to  become  overheated.  The  tissues, 
under  such  circumstances,  are  imperfectly  defecated, 
and  rapidly  pass  into  a  condition  of  imperfect  nutri- 
tion. This  depresses  all  the  functions  of  the  body, 
and  renders  the  nervous  system  inordinately  irritable. 
Sleep  cannot  be  profound  and  refreshing,  because  of 
the  over-excitable  state  of  the  brain.  During  the  long, 
hot  season  in  tropical  countries,  it  often  becomes  nee- 


RELIEF  BY  COOL  AIR.  45 

essary  to  seek  a  temporary  retreat  among  the  high- 
lands and  mountains,  in  order  to  find  a  climate  suffi- 
ciently dry  and  cool  to  furnish  the  condition  for 
refreshing  sleep.  For  the  same  reason  many  of  the 
inhabitants  of  the  Southern  United  States  are  forced 
to  spend  the  summer  months  in  the  invigorating 
atmosphere  of  Minnesota  and  Northern  Michigan. 
One  of  the  most  delightful  of  experiences  may  be  pro- 
cured on  anyVarm  day  in  summer  by  embarking,  at 
Chicago,  upon  one  of  the  steamboats  bound  to  Macki- 
nac. At  the  wharf,  in  the  hottest  and  dirtiest  part  of 
the  city,  all  is  dust,  perspiration,  and  discomfort.  The 
wide  cabins  are  filled  with  people  who  are  tired,  thirsty, 
and  discouraged.  Sickly,  squalling  babies  swarm  in 
numbers  sufficient  to  drive  one  mad.  As  the  sun  goes 
down,  the  signal-whistle  sounds,  head-lines  and  stern- 
lines  are  quickly  cast  off,  the  propeller  churns  the 
mire  behind  the  boat.  Slowly  swings  the  huge  fabric 
away  from  the  shore,  gliding  between  the  walls  of  sun- 
scorched  brick  that  line  the  stream  on  either  side. 
At  last  the  light-house  at  the  mouth  of  the  river  is 
passed,  and  we  are  out  upon  the  blue  waves  of  Lake 
Michigan,  with  a  heavenly  breeze  searching  every 
crack  and  cranny  of  the  hull.  New  life  animates  every 
form,  and  presently  a  great  silence  pervades  the  bril- 
liant cabins.  The  children  have  left  their  woes  be- 
hind, and,  for  the  first  time,  in  many  weeks,  perhaps, 
they  and  their  weary  mothers  sleep  the  sleep  of  inno- 
cence and  peace. 

The  dependence  of  a  high  atmospheric  temperature 
upon  the  direction  of  the  wind  renders  the  course  of 
the  aerial  currents  a  matter  of  great  importance  in 


46  INSOMNIA. 

relation  to  sleep.  The  southerly  winds  which,  in  the 
northern  hemisphere,  are  hot  and  enervating,  always 
produce  an  increase  of  wakefulness.  The  winds  that 
blow  from  the  heated  deserts  of  Africa,  Arabia,  and 
Australia,  are  greatly  dreaded  upon  this  account,  as 
well  as  for  the  other  numerous  discomforts  which  fly  in 
their  train.  Their  cessation,  and  their  replacement  by 
a  cool,  polar  current  brings  relief  at  once.  The  changes 
thus  produced  in  the  electrical  condition  of  the  atmos- 
phere doubtless  contribute  more  than  is  usually  known 
to  these  results.  A  cloudless  sky  gives  evidence  of 
positive  electricity,  which  is  much  stronger  in  winter 
than  in  summer.'  Clouds  are  sometimes  positive  and 
sometimes  negative.  According  to  Fonssagrives  ^  the 
atmospheric  electricity  is  positive  during  northerly 
winds,  and  negative  during  the  prevalence  of  winds 
from  the  southerly  quarters  of  the  horizon.  Great 
disturbances  of  the  electrical  condition  of  bodies  is 
often  observed  during  the  occurrence  of  the  sirocco  in 
North  Africa.  Arago  has  related  the  case  of  an  officer 
in  the  French  army  ^  Avho  saw  sparks  of  electricity 
leaping  from  his  epaulettes  at  every  blast  of  the  sirocco 
encountered  on  a  march  in  the  neighborhood  of  Algiers. 
Such  atmospheric  disturbances  often  produce  very  dis- 
agreeable effects  upon  persons  of  a  nervous  tempera- 
ment. According  to  Fonssagrives  [loc.  cit.)  such 
patients  frequently  experience,  during  the  prevalence 
of  storms  which  traverse  great  distances,  a  high  de- 
gree of  insomnia,  together  with  headache,  pains  in  the 

'  Ganot's  Physics. 

'  Die.  Eiicyc.  des  Set.  MM. ,  Art.  Climat. 

^  Comptes-rendus  Acad,  des  Sci.,  1840,  t.  XI,  p.  823. 


EFFECTS   OF   COLD.  47 

limbs,  joints,  and  old  injuries,  and  a  general  indefinable 
sensation  of  discomfort.  S.  Weir  Mitchell  has  care- 
fully traced  the  connection  between  these  phenomena 
and  the  variations  of  barometric  pressure  which  accom- 
pany the  revolving  storms  that  cross  the  continent  in  a 
northeasterly  direction.  ^ 

Though  the  effect  of  a  high  atmospheric  tempera- 
ture is  unfavorable  to  sleep,  an  excessive  temperature 
produces  the  opposite  condition.  Stupor  rather  than 
sleep  is  the  consequence  of  insolation  and  of  exposure 
to  great  heat  from  artificial  sources.  This  is  a  patho- 
logical process,  and,  therefore,  must  not  be  mistaken 
for  natural  sleep.  It  may  result  either  from  cerebral 
congestion,  or  from  cardiac  exhaustion,  and  is  character- 
ized by  an  extraordinary  bodily  temperature  and  a  high 
rate  of  mortality.^  So  elaborate  are  the  arrangements 
for  the  preservation  of  a  uniform  temperature  through- 
out the  body  that  it  is  practically  impossible  for  a  sun- 
stroke to  occur  unless  the  regulative  apparatus  has 
been  previously  deranged  by  ill-health. 

Excessive  cold  operates  in  like  manner  to  produce 
a  condition  of  stupor  that  tends  to  a  fatal  termination. 
But  moderate  degrees  of  cold  act  as  excitants  of  wake- 
fulness. By  effecting  a  contraction  of  the  vessels  of 
the  skin  cutaneous  circulation  is  impeded.  The  venous 
side  of  the  circulatory  apparatus  becomes  overloaded 
with  blood;  the  exhalation  of  carbonic  acid  and  the 
production  of  heat  are  reduced.  The  discomfort  that 
results  from  this  disturbance  of  the  natural  functions 

^Am.Journ.  Med  Sci.,  April,  1877,  p.  305. 

^A  remarkable  illustration  of  this  will  be  found  related  in  The 
Lancet,  July  26,  1884,  p.  112. 


48  INSOMNIA. 

of  the  tissues  is  sufficient  to  arouse  the  brain  to  wake- 
fulness, just  as  an  imperfect  oxidation  of  the  blood 
serves  to  excite  the  respiratory  centre  in  the  medulla 
oblongata.  It  is  hardly  necessary  to  allude  in  this 
connection  to  the  increased  flow  of  blood  through  the 
brain  occasioned  by  this  as  by  every  other  excitement 
of  the  sensorium.  Local  refrigeration  of  any  portion 
of  the  body  thus  acts  as  a  painful  excitant  of  the  cere- 
brum, and  produces  wakefulness,  very  much  as  disten- 
tion of  the  intestines  with  gas  will  keep  one  awake. 
It  is  for  this  reason  almost  impossible  to  sleep  with 
cold  feet.  Conditions  of  this  sort  are  pathological, 
and  are  far  in  excess  of  the  agreeable  coolness  which 
favors  sleep.  The  effects  of  progressive  diminution  of 
the  temperature  of  the  air  are  well  illustrated  by  the 
hibernation  of  animals.'  As  the  temperature  of  the 
air  diminishes,  in  winter,  animals  like  the  marmot  fall 
into  a  species  of  sleep.  Their  movements  of  respira- 
tion and  circulation  are  greatly  reduced,  and  their 
bodily  temperature  falls,  though  it  always  remains 
several  degrees  above  the  temperature  of  the  surround- 
ing air.  So  long  as  the  average  degree  of  cold  is 
maintained,  the  little  creature  sleeps  naturally ;  but,  if 
the  air  becomes  extraordinarily  cold,  the  physiological 
repose  of  the  animal  is  disturbed.  H  becomes  uneasy, 
wakes  up,  and  seeks  a  warmer  retreat.  ,  Too  great  a 
degree  of  cold  thus  becomes  a  cause  of  wakefulness. 
If  the  animal  under  these  circumstances  fails  to  secure 
protection  against  a  falling  temperature,  it  passes  into 
a  state  of  lethargy  that  is  often  fatal — a  pathological 
condition  being  substituted  for  the  physiological  sleep 

"^  Die.  Encyc.  des  Sci.  M^d.,  Art.  Froid,  p.  139. 


SENSORY   DISTURBANCES.  49 

of  ordinary  hibernation.  In  like  manner  the  human 
animal  may  experience  the  threefold  effects  of  refrig- 
eration :  first  a  pleasing  coolness  that  favors  sleep ;  then 
an  uneasy  sensation  of  cold  which  causes  wakefulness ; 
and,  finally,  a  lethargy  that  paralyzes  all  the  functions 
of  the  body  and  terminates  in  death. 

2.  Affections  of  the  nerves  of  common  sensation. — 
Chief  among  the  causes  of  sleeplessness  thus  produced 
is  pain.  This  is  a  modification  of  feeling,  caused  by 
excessive  or  extraordinary  excitement  of  the  peripheral 
nerves  of  sensation.  The  seat  of  the  excitement  may 
be  in  the  skin  or  in  the  deeper  tissues  of  the  body. 
Cutaneous  pain  may  be  caused  by  the  activity  of 
various  insects,  like  flies,  mosquitos,  fleas  and  bed- 
bugs, or  by  the  presence  of  certain  parasites,  such  as 
the  itch-mite,  or  by  ordinary  diseases  of  the  skin,  of 
which  notable  examples  are  found  in  erysipelas,  ery- 
thema, urticaria,  lichen,  prurigo,  certain  varieties  of 
eczema  and  psoriasis.  The  troublesome  forms  of 
pruritus  which  accompany  icterus,  or  which  may  occur 
without  any  clearly  defined  cause,  are  frequent  causes 
of  wakefulness.  The  last  mentioned  disorder  must, 
however,  be  sometimes  recognized  as  a  consequence  of 
central  nervous  disorder,  rather  than  a  result  of  peri- 
pheral disease.  Witness  the  frightful  itching  some- 
times experienced  during  the  progress  of  chronic 
myelitis.  All  kinds  of  injuries,  wounds,  ulcers,  and 
other  local  inflammations  are  common  causes  of  in- 
somnia by  reason  of  the  painful  impressions  trans- 
mitted from  them  to  the  brain.  Hence  the  great 
importance  of  anodynes  and  hypnotic  remedies  in  the 
course  of  surgical  practice.  Diseases  or  injuries  of 
4 


50  INSOMNIA. 

the  various  peripheral  nerves  are  notable  causes  of 
sleeplessness.  Witness  the  horrible  wakefulness 
caused  by  neuritis  and  by  neuralgia.  The  develop- 
ment of  neuromata  in  the  stumps  of  amputated  limbs 
may  thus  become  a  most  painful  cause  of  insomnia. 
Inflammations  which  encroach  upon  sensitive  nerves 
produce  intense  pain  with  consequent  loss  of  sleep. 
Of  this  very  conspicuous  examples  are  furnished  by 
spinal  meningitis,  and  by  the  effects  of  local  periostitis 
causing  compression  of  the  branches  of  the  fifth  pair 
of  nerves. 

3.  Affections  of  the  sympathetic  yierves. — So  much 
still  remains  to  be  learned  concerning  the  pathological 
functions  of  the  sympathetic  nerves  that  it  is  impossi- 
ble to  assign  with  any  great  degree  of  precision  the 
exact  amount  of  interference  with  sleep  that  may  de- 
pend upon  disordered  conditions  of  this  portion  of  the 
nervous  system.  Since  their  principal  functions  con- 
sist in  the  regulation  of  the  flow  of  blood  and  lymph 
throughout  the  body,  and  in  the  control  of  the  pro- 
cesses of  nutrition,  calorification,  secretion  and  excre- 
tion, it  follows  that  any  considerable  derangement  of 
their  healthy  action  must  be  represented  by  a  cor- 
responding disturbance  of  the  brain.  This  may  reach 
the  field  of  consciousness  in  the  form  of  pain,  and  thus 
may  become  a  cause  of  sleeplessness.  In  all  the  phe- 
nomena of  inflammation  sympathetic  nerves  play  an 
active  part.  In  certain  portions  of  the  body,  as  in  the 
principal  viscera,  and  in  the  periosteal  covering  of  the 
bones,  they  are  the  interstitial  nerves  of  the  structures. 
When  the  body  is  in  a  healthy  condition  these  nerves 
convey  impulses  of  a  sensory  character  which  do  not 


MORBID   STATES   OF  THE  NERVOUS   SYSTEM.      51 

reach  the  cerebral  organ  of  conscious  sensation.  But 
in  certain  morbid  states  they  become  inordinately  sen- 
sitive, and  they  then  serve  to  convey  and  probably  also 
to  magnify  sensations  to  an  extent  that  may  cause 
exquisite  pain  with  all  its  consequences.  Witness  the 
pain  experienced  during  the  various  forms  of  colic. 
Rheumatic  inflammations,  pleurisy,  pericarditis,  peri- 
tonitis, cystitis,  metritis,  ovaritis,  gastro-enteritis,  and 
other  similar  diseases  owe  their  principal  suffering  to 
the  affection  of  the  sympathetic  nerves  connected  with 
the  respective  organs  which  become  the  seat  of  pain. 
Including  with  the  sympathetic  nerve  the  pneumo- 
gastric  nerve,  which  occupies  a  functional  position 
between  the  strictly  peripheral  and  the  ganglionic 
nerves,  all  the  various  forms  of  pain  and  uneasiness 
experienced  in  the  region  of  the  heart  and  of  the  lungs 
may  be  assigned  to  this  system  of  nerves.  Thus  the 
various  species  of  respiratory  disturbance,  such  as 
asthma  and  dyspnoea  from  any  cause,  and  the  forms 
of  palpitation  and  other  cardiac  disorder  may  become 
causes  of  wakefulness.  In  like  manner  the  vague  and 
uneasy  sensations  associated  with  certain  varieties  of 
dyspepsia  are  frequent  sources  of  sleeplessness,  not 
merely  by  reason  of  the  pain  which  they  occasion,  but 
also  because  of  the  general  disorders  of  nutrition  with 
which  they  are  associated. 

II.  Insomnia  caused  by  moebid  states  of  the  cen- 
tral NEEVOUS  ORGANS. 

So  intimately  connected  are  the  spinal  cord  and  the 
brain  that  their  disorders  may  properly  be  considered 
together.     These  may  be  classified  as: 

1.   Disorders  of  circulation  and  nutrition. 


52  INSOMNIA. 

2.  Inflammations  and  degenerations. 

3.  Neoplastic  encroachments. 

Disorders  of  circulation  and  nutrition. — Hyperaemia 
of  the  brain  is  a  frequent  cause  of  wakefulness.  This 
may  be  maintained  by  an  unconscious  effort  of  the 
organ  of  the  will  under  the  influence  of  any  great  and 
unusual  excitement  of  the  mind.  So  soon  as  the  men- 
tal excitement  is  allayed,  the  excessive  afflux  of  blood 
subsides,  and  the  brain  becomes  fitted  for  sleep.  But, 
if  excitement  be  too  far  prolonged,  the  nutrition  of  the 
nervous  centres  suffers,  and  the  regulative  apparatus 
of  the  cerebral  circulation  becomes  exhausted,  so  that 
the  brain  cannot  rest,  because  its  inhibitory  centres 
have  lost  their  power  of  control  over  the  lower  ganglia 
of  the  organ.  The  cerebro-spinal  centres  are  then  in 
a  condition  analogous  to  that  of  a  locomotive  engine 
on  which  the  engineer  can  no  longer  regulate  the  pro- 
duction and  distribution  of  steam.  Such  a  condition 
is  usually  the  result  of  numerous  antecedent  causes. 
Long  hours  of  work,  scanty  or  improper  food,  insuf- 
ficient sleep,  bad  hygienic  surroundings  and  habits, 
with  indulgence  in  the  use  of  narcotics  and  stimulants, 
are  among*  the  most  common  causes  of  the  disorder. 

Active  hypersemia  of  the  nervous  centers  has  been 
above  mentioned  as  the  consequence  of  cerebral  func- 
tion under  unfavorable  conditions.  But,  as  the  disor- 
der persists,  its  type  undergoes  a  change.  We  still 
speak  of  the  disorder  as  functional  in  its  character,  but 
it  continually  tends  to  become  organic.  No  visible 
alterations,  perhaps,  can  be  detected,  but,  evidently, 
there  are  radical  changes  in  the  substance  of  the  nerv- 
ous tissue.     Nutrition   suffers  throughout  the  body  to 


IRRITABILITY   OF  THE   BRAIN.  53 

a  degree  that  attracts  attention.  The  blood  diminishes 
in  quantity  and  quality,  till  the  patient  becomes  nota- 
bly anaemic.  In  this  condition  the  brain  is  inordinately 
excitable.  It  is  incapable  of  sustained  activity,  and 
the  patient  may  even  be  oppressed  by  an  inclination  to 
constant  drowsiness;  yet  he  will  be  unable  to  sleep 
soundly,  and  his  sleep  will  be  continually  agitated  by 
dreams.  This  state  is  one  of  the  constant  accompani- 
ments of  slow  starvation.  The  molecular  structure  of 
the  nervous  organs  seems  to  be  so  slightly  constructed, 
under  such  circumstances,  that  its  equilibrium  is  dis- 
turbed by  the  most  trifling  incidents.  It  may  be 
likened  to  a  lofty  wall  of  bricks  laid  up  without  mor- 
tar—  "if  a  fox  go  up,"  the  entire  structure  may  be 
thrown  down  with  a  tremendous  noise.  Thus  the 
ansemic  and  irritable  brain  will  react  excessively  under 
the  slightest  impression;  consciousness  is  invaded  by 
perceptions  which  would  never  arise  under  normal  con- 
ditions of  the  nervous  tissue ;  and  the  mind  is  continu- 
ally aroused.  This  form  of  wakefulness  is  very  fre- 
quent among  women  who  have  become  anaemic,  and 
among  patients  who  are  slowly  convalescing  from 
exhausting  diseases. 

It  is  impossible  in  every  instance  to  decide  whether  a 
given  state  of  wakefulness  is  the  result  of  cerebral  hy- 
peraemia  or  anaemia.  In  the  one  case  the  persistence  of 
wakeful  activity  of  the  mind  is  due  to  excitement  of  the 
cerebral  cells,  accompanied  by  a  lavish  irrigation  of 
their  substance  with  the  plasma  of  the  blood.  In  the 
other  case  the  excitement  is  occasioned,  not  so  much 
by  increased  afflux  of  the  blood,  as  by  a  morbid  insta- 
bility of  the  nervous  substance.     The  outcome  in  both 


54  INSOMNIA. 

cases  is  very  similar — mental  excitement  and  wake- 
fulness. 

In  a  third  class  of  cases  the  agitation  of  the  brain 
is  produced  by  the  direct  action  of  certain  chemical 
agents  upon  the  cortical  substance.  Tea  and  cofiPee 
are  familiar  examples  of  such  agents.  The  caffeine, 
by  virtue  of  which  they  produce  their  effect,  when 
transported  to  the  brain,  enters  into  combination  with 
its  protoplasm  in  such  a  way  as  to  stimulate  molecular 
movement.  Perception  is  thus  quickened,  and  the 
mind  is  aroused.  Sleep  is  postponed  until  the  effect 
of  the  stimulant  has  subsided.  This  form  of  Avakeful- 
ness  is  quite  different  from  that  produced  by  alcoholic 
drinks.  These  operate,  when  taken  in  small  quanti- 
ties, to  favor  cerebral  equilibrium  —  and  consequent 
equanimity — ^by  producing  a  general  dilatation  of  the 
smaller  blood-vessels.  Their  anaesthetic  influence  is 
favorable  to  sleep,  under  such  circumstances.  But,  if 
frequently  repeated,  these  doses  of  alcohol  modify  the 
nutrition  of  the  nervous  system  until,  at  last,  a  condi- 
tion of  irritable  weakness  is  reached,  in  which 
wakefulness  of  a  most  distressing  character  is  expe- 
rienced. 

Inflammations,  degenerations,  and  neoplasms. — The 
early  stages  of  inflammation  involving  the  central  nerv- 
ous organs  are  marked  by  that  form  of  insomnia  whicli 
is  associated  with  active  hypersemia.  The  headache 
and  painful  delirium  which  accompany  the  different 
varieties  of  meningitis,  are  causes  of  a  wakefulness  that 
persists  until  the  brain  is  merged  in  the  coma  of  com- 
pression. The  interstitial  changes  which  cause  the 
various  forms  of  insanity,  are  in  like  manner  causes  of 


MAL  -  NUTRITION   OF  THE  BRAIN.  55 

wakefulness.  Local  injuries  and  degenerations  of 
brain-substance,  tubercular  deposits  upon  the  menin- 
gies,  and  all  the  different  forms  of  intra-cranial  tumor, 
are  causes  of  wakefulness,  both  by  reason  of  the  direct 
irritation  which  they  produce,  and  by  reason  of  the 
circulatory  disturbances  which  arise  in  their  neigh- 
borhood. 

Finally,  it  must  be  observed  that  wakefulness  may 
result  from  excitement  of  the  brain  by  irritating  sub- 
stances transported  through  the  blood  from  distant 
centers  of  disease  in  remote  organs  of  the  body,  or 
derived  from  articles  that  have  been  absorbed  with  the 
food  and  drink,  or  with  the  air  that  enters  the  lungs. 
Thus  wakefulness  may  accompany  cutaneous  disorders 
that  interfere  with  perspiration.  Imperfect  elimina- 
tion through  the  liver,  kidneys  and  intestines,  leaves 
the  blood  charged  with  excrementitious  substances 
which  arouse  the  brain  to  wakefulness.  In  like  man- 
ner, various  poisons,  like  lead,  arsenic,  etc.,  different 
miasms  of  telluric  origin,  the  products  of  putrefaction, 
and  the  various  animal  contagia,  may  produce  insom- 
nia by  their  prejudicial  effect  upon  the  nutrition  of  the 
nervous  structures  throughout  the  body. 


CHAPTER   III. 


REMEDIES   FOR   INSOMNIA. 


O.  true  apothecary ! 
Thy  drugs  are  quick. 


—Romeo  and  Jttliet. 


An  occasional  attack  of  wakefulness  may  fall  to  the 
lot  of  any  one  as  a  consequence  of  the  various  disturb- 
ances of  health  or  equanimity  of  mind  to  which  all 
are  liable.  Occurring  as  an  accident  in  a  state  of 
health,  it  produces  merely  a  feeling  of  lassitude  and 
weariness,  during  the  subsequent  day.  This  soon  dis- 
appears, after  a  night  of  refreshing  sleep,  and  the 
subject  is  nothing  worse  for  the  incident.  But  the 
recurrence  of  the  disorder  is  a  thing  to  be  deprecated, 
not  only  for  the  reason  that  it  denotes  a  departure  from 
the  physiological  order  of  life,  but  because  its  frequent 
repetition  prevents  the  adequate  repair  of  the  tissues 
of  the  body.  The  great  function  of  nutrition  suffers 
as  a  consequence,  and  the  patient  rapidly  falls  into  a 
condition  of  premature  old  age.  When  this  takes 
place  as  a  result  of  some  temporary  error  of  hygiene, 
or  as  a  consequence  of  diseases  which  admit  of  suc- 
cessful treatment,  the  patient  may  be  restored  to  health 
by  judicious  management,  but  lost  youth  and  elasticity 
of  the  tissues  can  never  be  fully  regained.  The  most 
formidable  cases  of  insomnia  are  those  for  which  no 
adequate  cause  can  be  recognized  in  the  habits,  mode 

(56) 


SIGNIFICANCE   OF  INSOMNIA.  57 

of  life,  and  state  of  health  of  the  patient.  Grave  and 
permanent  disorder  of  the  brain  is  then  to  be  feared. 
Such  wakefulness  is  a  frequent  precursor  of  acute 
meningitis  in  children  and  adults.  It  frequently  ushers 
in  the  early,  insidious,  formative  stage  of  tubercular 
meningitis,  and  of  the  infective  fevers  —  notably 
typhoid  fever.  It  forms  one  of  the  most  suspicious 
symptoms  among  the  introductory  phenomena  of 
insanity ;  and  during  the  course  of  protracted  diseases, 
its  intrusion  is  an  omen  of  most  unfavorable  augury. 
It  will,  therefore,  be  found  useful  to  consider  with 
some  degree  of  detail  the  circumstances  under  which 
insomnia  may  occur,  and  the  best  means  of  averting 
its  onset. 

A  severely  logical  reference  to  previous  doctrines 
regarding  the  condition  of  the  brain  during  sleep,  has 
led  many  authors  to  consider  the  therapeutical  treat- 
ment of  insomnia  chiefly  as  a  matter  of  modification  of 
the  cerebral  circulation.  Sleep  has  been  supposed  to 
depend  upon  a  comparatively  bloodless  state  of  the 
brain,  and  wakefulness  upon  the  contrary  state.  For 
such  theorists  the  treatment  of  insomnia  consists  very 
simply  in  the  use  of  agents  which  are  supposed  to  be 
efficacious  in  reducing  the  flow  of  blood  through  the 
head.  Tourniquets,  placed  upon  the  carotid  arteries, 
occupy  a  position  of  great  honor  in  the  armamentari- 
um of  such  people.  Recognizing  the  fact  that  changes 
in  the  force  of  the  circulation  accompany  and  sustain 
every  change  in  the  activity  of  the  cerebral  cortex,  we, 
however,  attach  the  greatest  importance  to  the  condi- 
tion of  the  nervous  substance  itself.  For  a  clear 
understanding  of  the  proper  mode  of  medication,  it  is 


58  INSOMNIA. 

important  to  ascertain  whether  the  cerebral  substance 
is  in  a  state  of  normal  activity,  or  whether  it  is  in  a 
state  of  healthy,  but  excessive,  activity,  or  whether  its 
seeming  excitement  is  merely  the  result  of  irritable 
weakness.  Since  these  opposite  conditions  may  de- 
clare themselves  during  the  course  of  any  disease  in 
which  insomnia  may  become  a  troublesome  phenome- 
non, it  is  impossible  to  make  a  classification  of  dis- 
eases upon  the  basis  of  these  different  states  of  the 
brain.  It  will,  therefore,  be  found  more  useful  to  con- 
sider the  subject  of  sleeplessness  as  it  ordinarily  pre- 
sents itself  during  the  clinical  progress  of  the  several 
forms  of  disease.  It  will,  then,  appear  that  the  type 
of  insomnia  is  liable  to  variation  with  the  course  of 
each  individual  malady;  and  its  treatment  must  vary 
accordingly. 

Before  proceeding  to  a  discussion  of  the  therapeu- 
tics of  insomnia  in  connection  with  particular  diseases, 
it  will  be  advantageous  to  pass  briefly  in  review  the 
different  remedies  which  are  useful  in  the  treatment  of 
wakefulness.  These  may  be  divided  into  two  classes: 
Nervous  stimulants,  and  nervous  sedatives.  Among 
the  first  may  be  also  reckoned  food,  heat,  baths,  and 
counter-irritants.  Like  all  nervous  stimulants,  they 
promote  the  complete  and  harmonious  action  of  all 
parts  of  the  nervous  system,  favoring  that  equilibrium 
of  the  circulation  which  is  most  favorable  to  the  devel- 
opment of  sleep.  The  second  class  of  agents  com- 
prises all  such  remedies  as  act  directly  upon  the 
nervous  tissue  of  the  brain,  depressing  its  functional 
activity,  and  hushing  to  rest  those  particular  organs 
which,  by  their  undue  excitement,  serve  to  keep  the 


REMEDIES  FOR  INSOMNIA. 


59 


remainder  in  a  state  of  wakefulness.  All  these  sub- 
stances produce  decided  effects  upon  the  spinal  cord 
and  the  peripheral  nerves,  but  it  is  their  operation 
upon  the  brain  which  principally  interests  us  in  con- 
nection with  insomnia. 


Nervous  Stimulants 


Nervous  Sedatives. 


Heat. 

Cold. 

Baths. 

Alcohol. 

Massage. 

Paraldehyde. 

Electricity. 

Ether. 

Counter-irritants. 

Chloroform 

Food. 

Chloral. 

Digitalis. 

Butylchloral  hydrate, 

Camplior. 

Amyl  nitrite, 

Musk. 

Opium  and  opiates. 

Valerian. 

Bromides. 

Cannabis  indica. 

Hops. 

Belladonna. 

Gelsemium. 

Hyoscyamus. 

Conium. 

Stramonium. 

Phosphorus. 

Acids 

• 

Opium, 

NERVOUS    STIMULANTS. 

It  may  at  first  sight  seem  to  be  a  contradiction  in 
terms  when  it  is  asserted  that  sleep  may  result  from 
the  administration  of  a  nervous  stimulant.  This  does 
occur,  but  only  indirectly,  and  as  a  consequence  of  a 
restoration  of  energy  to  those  portions  of  the  nervous 
system  which  serve  to  moderate  the  activity  of  the 
organ  of  the  mind  —  the  cortex  of  the  cerebrum. 

Heat,  for  example,  is  an  undoubted  stimulant. 
When  added  to  the  body  in  quantity  sufficient  to  over- 
come chilliness,  it  tends  to  equalize  the  circulation  of 


60  INSOMNIA. 

the  blood,  and  produces  throughout  the  body  a  nerv- 
ous equilibrium  that  prevents  any  particular  organ 
or  member  from  arousing  the  others  to  wakefulness. 

Baths. — The  application  of  heat  in  the  form  of  a 
warm  bath  constitutes  one  of  the  most  admirable  means 
of  tranquilizing  the  brain.  Children  who  are  restless 
at  night  are  delightfully  soothed  by  a  warm  bath  every 
night  and  morning.  The  water  should  be  of  an  agree- 
able temperature — ^this  is  better  than  any  exact  figure 
upon  the  scale  of  a  thermometer — and  the  bath  should 
not  last  logger  than  ten  minutes.  Similar  baths  exer- 
cise a  happy  effect  upon  adult  patients  who  are 
moderately  feverish,  nervous,  and  wakeful.  If  strong 
enough,  they  may  take  a  full  bath  at  bedtime;  but  if 
too  feeble  to  leave  the  bed,  gentle  sponging  with  warm 
water  will  prove  most  refreshing,  and  will  usually  be 
followed  by  restful  sleep.  The  well-known  derivative 
effects  of  hot  foot  baths  scarcely  need  to  be  more 
than  mentioned  in  this  connection. 

Turkish  baths  form  an  invaluable  adjuvant  in  the 
treatment  of  clfi'ohic  cases  of  insomnia  arising  from 
rheumatic,  gouty,  and  dyspeptic  disorders  of  the  health. 
The  copious  perspiration  induced  by  the  heated  air  of 
the  hot  chamber  is  depurative,  while  the  cold  douche 
and  the  massage  with  which  the  bath  is  concluded 
have  a  powerful  effect  to  stimulate  all  the  functions  of 
the  body.  By  this  means  the  brain  is  enabled  to  re- 
sume a  healthier  mode  of  action,  and  sleep  follows  as  a 
matter  of  course. 

Massage. — This  constitutes  a  process  of  rubbing 
and  kneading  the  body.  It  has  been  practiced  from 
time  immemorial   among  the   oriental  races   and  the 


MASSAGE.  61 

Pacific  Islanders  as  a  means  of  relief  from  fatigue  of 
every  kind.  Among  the  Japanese  the  practice  of 
massage  is  a  monopoly  in  the  hands  of  the  blind,  who 
are  thus  enabled  to  support  themselves.  Various 
modifications  of  the  oriental  method  have  been  intro- 
duced under  the  names  of  percussion,  shampooing,  and 
the  Swedish  movement  cure.  They  all  possess  the  com- 
mon features  of  friction  applied  with  the  hand  to  the 
skin,  compression  of  the  muscles  with  the  hands,  and 
passive  movements  of  the  different  articulations  of  the 
limbs  and  body.  For  effecting  all  these  processes 
nothing  has  yet  surpassed  the  Sandwich  Island  lomi- 
lomi  as  practised  by  the  court-retainers  of  the  ancient 
chiefs.  As  a  means  of  relieving  fatigue,  and  of 
removing  muscular  soreness,  after  violent  exertions 
of  every  kind,  it  is  far  superior  to  the  imitations 
performed  by  European  and  American  professional 
masseurs  and  masseuses.  Nervous  headaches,  the 
pains  that  accompany  spinal  irritation,  and  all  con- 
ditions of  restlessness  and  wakefulness  which  depend 
upon  exhaustion  are  relieved  by  this  method.  The 
well-known  soothing  influence  of  a  mother's  hand 
stroking  the  face  and  forehead  of  her  sleepless  child, 
is  an  example  of  only  one  of  the  effects  thus  produced 
by  the  skillful  masseur.  These  salutary  results  must 
be  assigned  to  the  uniform  friction  of  the  skin,  causing 
the  liberation  of  heat,  and  modifying  the  electrical 
conditions  of  the  body.  By  this,  the  impressions  de- 
rived from  the  peripheral  nerves  are  reduced  to  a  more 
harmonious  series.  The  circulation  of  blood  and 
lymph  is  rendered  more  active  in  the  substance  of  the 
muscles,  and  all  the  processes  of  nutrition  are  thus 


B2  INSOMNIA. 

stimulated  to  a  degree  that  restores  the  equilibrium  of 
function  throughout  the  nervous  system.  Being  no 
longer  irritated  by  suffering  portions  of  the  body  with 
which  it  is  connnected,  the  brain  then  yields  to  the 
effects  of  its  own  fatigue,  and  sleep  supervenes. 

EledricUy  is  chiefly  useful  in  those  cases  where 
it  is  impossible  to  discover  anything  but  cerebrasthenia 
as  the  cause  of  wakefulness.  According  to  Beard  and 
Rockwell,'  sleep  may  result  from  the  use  of  any  one  of 
the  different  methods  of  electrization.  The  passage  of 
a  moderate  current,  either  galvanic  or  faradaic, 
through  any  portion  of  the  body  often  produces  a 
temporary  feeling  of  sleepiness;  but  the  long  con- 
tinued employment  of  electricity  is  needful  to  effect 
those  changes  in  cerebral  nutrition  which  are  necessary 
for  a  permanent  cure  of  insomnia.  In  cases  of  sleep- 
lessness caused  by  worry  and  overwork,  great  benefit 
is  often  experienced  from  the  daily  passage  of  the 
faradaic  current  from  the  back  of  the  neck,  or  from  the 
pit  of  the  stomach,  to  the  feet.  Static  electricity,  and 
the  electric  bath,  are  also  very  effective  in  many  cases 
of  so-called  spinal  irrUation  and  insomnia. 

Counter -irrif ants  are  substances  which  are  applied 
to  the  surface  of  the  body  for  the  purpose  of  com- 
municating to  the  superficial  sensory  nerves  impulses 
(irritation)  which  may  serve  to  inhibit  the  morbid 
functions  of  distant  or  central  nervous  structures. 
Various  explanations  of  this  process  have  been  pre- 
sented; notably  a  most  ingenious  argument  by  Dr.  T. 
Lauder  Brunton  '^  in  favor  of  the  theory  of  inhibition 

"^  Medical  and  Surgical  Electricity,  4th  ed.,  p.  413. 
"^Nature,  March,  1883, 


COUNTER  -  IRRITANTS.  63 

by  interference  of  vibrations — impulses  from  the  peri- 
phery interfering  with  vibrations  originating  in  morbid 
conditions  of  the  central  nervous  organs — very  much 
as  darkness  is  produced  by  the  interference  of  lumi- 
nous undulations,  and  silence  is  effected  by  interfer- 
ence of  sonorous  waves  in  the  atmosphere.  This 
hypothesis  is  the  one  that  is  most  conformable  to  the 
present  requirements  of  science,  and  is  hereby  ac- 
cepted as  the  most  satisfactory  explanation  of  the 
action  of  counter-irritants. 

The  drugs  in  general  use  for  the  purpose  of  counter- 
irritation  are  cantharides,  capsicum,  mustard,  thapsia, 
turpentine,  aconite,  and  crotwi  oil.  Cups,  leeches,  and 
certain  special  applications  of  electricity,  also  owe 
much  of  their  virtue  to  the  same  power  of  modifying 
functions  at  a  distance.  Under  the  influence  of  all  these 
agents  the  molecular  vibrations  of  the  brain  may  be 
profoundly  influenced ;  pain  may  be  annulled,  and  sleep 
be  procured.  The  circulation  of  the  blood  is  so  power- 
fully affected  by  these  measures  that  their  good  effects 
are  usually  attributed  to  the  circulatory  changes  thus 
produced.  But,  as  in  all  other  modifications  of  the 
circulation,  the  nervous  tissues  and  the  vascular  chan- 
nels must  first  be  reached  by  influences  unconnected 
with  the  blood  itself  before  its  current  can  be  diverted 
from  one  region  to  another.  The  inhibitory  action 
upon  the  nervous  organs  is  the  primary  effect.  The 
diversion  of  the  circulation  is  a  secondary  consequence, 
by  which,  undoubtedly,  the  degree  of  nervous  change 
can  be  estimated,  and  by  which  the  inhibitory  effects 
in  the  brain  are  intensified  and  sustained. 

Food, — In  a  considerable  number  of  cases  of  insom- 


64  INSOMNIA. 

nia,  its  cause  lies  in  an  irritable  weakness  of  the  nerv- 
ous tissues.     Exhausted  by  overwork,  or  debilitated  by 
the  loss  of  blood,  or  half-starved  during  the  course  of 
a  long  illness  like  typhoid  fever,  a  condition  of  wake- 
fulness may  be  established  which  will  add  to  the  dan- 
gers experienced  by  the  patient.     In  this  state  there . 
is   great    restlessness  —  the    sufferer    experiences    no 
severe    pain,   but  he   cannot  lie   still.     This  form  of 
sleepless   agitation   is  often    encountered  during   the 
later  stages  of  exhausting   diseases ;  and,  if  not  prop- 
erly treated,  it  soon  leads  to  a  fatal  termination.     The 
most  important  remedy  for  such  distress  is  found  in 
food.     This  must  be  soluble,  diffusible,  stimulant,  and 
nutritive.     Milk,  alcohol,  eggs,  and  meat-juice,  are  the 
typical  representatives  of  such  food.     Milk  should  be 
as  fresh  as  possible,  and  should  be  slightly  salted,  in 
order  to  hinder  the  formation  of  hard  curds  in  the 
stomach.     For  young   children  it  may  be  jpepionized 
with    advantage   by  gently  heating  one  pint  of  milk 
Avith  five  grains  of  sodium  carbonate  and  five  grains  of 
pancreatic  extract  dissolved  in  half  a  pint  of  water. 
The  mixture  may  be  sufficiently  warmed  by  placing  it 
in  a  bottle  immersed  for  half  an  hour  in  a  jug  of  hot 
water  (Fairchild).     By  this  process  the  milk  is  partly 
digested  before  it  is  drank,  thus  relieving  the  alimen- 
tary canal  of  a  corresponding  amount  of  work. 

Furnished  in  the  form  of  koumiss,  milk  is  not  only 
presented  in  a  digestible  form,  but  the  alcohol  and  the 
acids  yielded  by  its  fermentation  are  powerful  aids  to 
the  process  of  digestion.  Fermented  milk  forms  a  con- 
siderable portion  of  the  daily  food  of  the  nomad  tribes 
of  Central  Asia,  and  it  is  highly  esteemed  among  the 


KOUMISS.  65 

Russians  in  the  treatment  of  pulmonary  consumption. 
It  is  useful  in  all  diseases  affecting  the  digestive 
organs,  and  can  often  be  tolerated,  even  by  very  young 
children,  when  nothing  else  will  remain  in  the  stom- 
ach. Considerable  mystery  is  made  of  its  preparation 
by  those  who  sell  it  for  an  enormous  price ;  but  its 
composition  is  really  very  simple,  and  its  actual  cost  is 
within  the  reach  of  every  one.  The  following  formula 
for  its  preparation  has  given  great  satisfaction  to  many 
of  my  patients: 

Dilute  five  quarts  of  milk  with  three  quarts  of  hot 
water.  When  lukewarm,  add  half  a  cupfull  of  sugar 
of  milk  (which  can  be  obtained  from  any  wholesale 
druggist),  and  one  bottle  of  well  fermented  koumiss 
(or  a  little  yeast).  Stir  the  mixture  thoroughly,  and 
let  it  stand  in  an  open  jar,  at  a  temperature  of  about 
72°  F.,  till  it  begins  to  curdle.  Then  stir  in  half 
a  cupfull  of  pulverized  coffee  sugar,  and  cork  tightly 
in  champagne  bottles  with  the  best  velvet  corks.  The 
bottles  should  be  kept  quite  cool,  as  fermentation  pro- 
ceeds very  briskly,  and  will  break  the  containers  if 
left  in  a  warm  room.  A  large  ice-box  is  the  best 
receiver  during  hot  weather.  The  koumiss  thus  pre- 
pared is  ready  for  use  at  the  end  of  a  week.  It  may 
be  most  conveniently  drawn  from  the  bottle  with  a 
champagne  tap.  The  entire  cost  of  the  article  need 
not  exceed  seven  cents  a  bottle. 

Sleeplessness  caused  by  chronic  dyspepsia  will  often 
yield  to  a  diet  of  koumiss,  when  every  other  remedy 
has  failed.  When  the  stomach  is  very  intolerant,  it 
should  at  first  be  taken  in  very  small  doses,  repeated 
as  often  as  every  hour.     It  will  soon  become  possi- 


66  INSOMNIA. 

ble  for  the  same  patient  to  drink  two  or  three  quarts 
each  day. 

Eggs  form  one  of  the  most  nutritious  and  easily 
digested  articles  of  diet.  They  should  be  taken 
uncooked,  beaten  up  with  milk  to  which  a  small  quan- 
tity of  wine  or  spirits  and  sugar  have  been  added.  A 
glass  of  eggnogg,  thus  prepared,  is  invaluable  in 
the  insomnia  of  fevers  and  other  conditions  of  ex- 
haustion. 

Meat-juice  can  be  procured  in  numerous  forms. 
The  various  soluble  extracts  of  meat,  Valentine's 
liquid  extract  of  beef,  Murdoch's  liquid  food,  all  repre- 
sent the  juice  that  oozes  from  rare  beef.  Its  nutritive 
value  is  not  very  great,  but  it  possesses  considerable 
energy  as  a  stimulant.  Meat  juice,  therefore,  occupies 
an  important  place  as  an  excitant  of  those  functions 
which  must  be  aroused  in  order  to  secure  the  proper 
digestion  of  other  articles  of  food.  It  should,  therefore, 
be  administered  in  connection  with  them.  x4.s  the 
ordinary  meat  extracts  are  frequently  very  unpalatable, 
they  may  be  administered  in  fresh  broth  or  soup,  to 
which  they  give  body  and  energy  without  unpleasantly 
affecting  their  savory  taste. 

Neurasthenic  patients,  whose  insomnia  results  from 
physical  exhaustion,  should  never  retire  at  night  with- 
out taking  some  form  of  light  and  easily  digested  food. 
A  simple  slice  of  bread,  or  a  piece  of  plain  sponge- 
cake, with  a  glass  of  koumiss,  forms  an  excellent  model 
for  such  a  meal. 

Digitalis  is  only  indirectly  useful  as  an  hypnotic. 
In  cases  of  cardiac  disease,  with  enfeeblement  of  the 
heart,  dyspnoea,  dropsy,  and  sleeplessness,  digitalis  is 


DIGITALIS  —  CAMPHOR  —  MUSK.  67 

often  of  the  greatest  service.  It  has  also  been  highly 
recommended  in  delirium  tremens.  Administered  in 
the  form  of  an  infusion,  it  has  been  given  in  doses  of 
a  tablespoonf ul,  every  four  hours,  with  apparently  good 
effect.  Its  use  is  indicated  in  cases  characterized  by 
weakness  of  the  heart,  with  a  rapid  and  feeble  pulse. 
Under  its  influence  the  state  of  the  circulation  im- 
proves, delirium  ceases,  and  sleep  occurs. 

Camphor. — This  substance  is  not  an  hypnotic,  but 
it  forms  a  valuable  addition  to  various  hypnotic  com- 
pounds. It  is  a  cerebral  stimulant,  and  aids  in  the 
establishment  of  that  nervous  tranquility  which  favors 
the  incidence  of  sleep.  It  may,  therefore,  be  advan- 
tageously associated  with  opiates  in  the  restlessness 
and  insomnia  of  exhaustion.  Tully's  Powder,  a  valua- 
ble substitute  for  Dover's  Powder,  contains  camphor. 
This  renders  it  preferable  to  the  ordinary  opiates  in 
typhoid  fever,  and  in  other  exhausting  diseases. 

Musk,  the  dried  secretion  of  the  preputial  follicles 
of  the  musk-deer,  is  a  substance  which,  on  account  of 
its  high  price,  is  rarely  used  as  an  hypnotic.  Given 
in  doses  of  ten  grains,  every  two  or  three  hours,  it  is 
exceedingly  valuable  (Stille  and  Maisch)  for  the  relief 
of  "  all  those  nervous  phenomena  which  are  represented 
by  the  term  ataxia,  and  among  them  subsultus  ten- 
dinum,  mild  muttering  delirium,  floccitation,  muscae 
volitantes,  and  hiccough,  with  a  small,  frequent,  tremu- 
lous or  irregular  pulse,  without  coma  and  without  col- 
lapse. Under  these  circumstances  musk  tends  to  pro- 
duce refreshing  sleep,  while  it  calms  muscular  spasm 
and  favors  perspiration,  while  the  pulse  grows  fuller, 
more  regular,  and  less  frequent.      ...     In  propor- 


68  INSOMNIA. 

tion  as  ataxic  prevail  over  adynamic  phenomena  is 
musk  advantageous."  Such  conditions  are  chiefly 
encountered  in  typhus,  typhoid  fever,  the  eruptive 
fevers,  and  pneumonia.  Musk  is  very  efficacious  for 
the  relief  of  "wakefulness  resulting  from  combined 
mental  and  bodily  fatigue — such  cases,  in  fact,  as  are 
benefitted  by  valerian,  camphor,  asafetida,  and  am- 
monia." 

Valerian  and  its  different  preparations  form  a  typi- 
cal class  of  agents  which  indirectly  favor  sleep  by  their 
gently  stimulant  effect  upon  the  brain.  They  are  all 
useful  in  quieting  that  form  of  hysterical  excitement 
to  which  women  are  liable  during  the  "  change  of  life." 
That  form  of  restlessness,  usually  resulting  from 
fatigue,  in  which  the  patient  feels  as  if  she  cannot  sit 
still,  is  often  relieved  very  promptly  by  the  valerianate 
of  ammonia.  Wakefulness  caused  by  neuralgic  pains, 
or  by  exhaustion,  often  yields  readily  to  scruple  doses 
of  valerianate  of  zinc  or  ammonia.  The  elixir  of  the 
valerianate  of  ammonia  is  a  very  elegant  preparation 
of  the  drug. 

Cannabis  Indica. — A  cerebral  stimulant  which  pro- 
duces, at  first,  an  agreeable  exaltation  of  the  mental 
faculties.  This  is  followed  by  a  condition  of  delirium, 
succeeded  in  its  turn  by  sleep.  It  is,  therefore,  im- 
possible to  use  the  drug  for  merely  hypnotic  purposes ; 
but  it  is  a  useful  adjuvant,  in  small  doses,  to  other 
hypnotic  remedies.  Given  in  doses  of  ^  —  1  grain, 
it  may  be  advantageously  associated  with  opiates,  or 
with  hyoscyamus  or  belladonna  in  cases  which  do  not 
easily  tolerate  the  preparations  of  opium.  The  tannate 
of  cannabin,  given  in  doses  varying  from  five  to  ten 


BELLADONNA.  69 

grains,  has  been  recommended  as  an  hypnotic;  but, 
like  the  extract  from  which  it  is  derived,  its  effects  are 
rather  uncertain.  The  pure  alkaloid,  cannabin,  has 
been  recently  introduced  as  a  soporific,  in  doses  of 
three-quarters  of  a  grain  to  a  grain  and  a  half.  Ac- 
cording to  Stille  and  Maisch,  the  Avakefulness  caused 
by  the  itching  of  eczema  may  be  relieved  by  the  use  of 
cannabis  indica.  The  uneasy  sleep  attendant  upon 
ungratified  sexual  appetite  may  also  be  relieved  in  the 
same  way,  since  the  drug  is  decidedly  anti-aphrodisiac. 
Belladonna  is  not  directly  hypnotic,  unless  given 
in  poisonous  doses,  but  its  medicinal  operation  tends 
to  overcome  certain  conditions  that  hinder  sleep.  By 
its  anti-spasmodic  effects  it  relieves  many  forms  of 
spasm  which  would  otherwise  interfere  with  sleep. 
Spasmodic  asthma  furnishes  an  example  of  such  an 
affection.  This  may  be  relieved  by  the  hypodermic 
injection  of  atropine.  Whooping  cough  is  another  dis- 
ease which  may  be  largely  controlled  by  the  internal 
administration  of  the  drug,  especially  by  inhalation  of 
a  spray  that  has  been  medicated  with  belladonna. 
Neuralgia,  especially  the  form  that  involves  the  head, 
face,  and  intercostal  nerves,  is  greatly  mitigated  by  the 
use  of  belladonna,  or  its  alkaloid,  atropia.  Its  asso- 
ciation with  opiates  seems  to  increase  their  hypnotic 
effect,  while  at  the  same  time  neutralizing  their  dis- 
agreeable action.  According  to  Curci,^  it  opposes  the 
tendency  of  opiates  to  cause  cerebral  hypersemia.  For 
this  reason  it  is  generally  advisable  to  combine  sul- 
phate of  atropia  with  sulphate  of  morphia  for  hypo- 
dermic use.     Of  the  former  1-100  —  1-80  grain  may 

*  Lo  Sperimentaie,  April,  1884. 


70  INSOMNIA. 

be  used  with  ^  grain  of  the  latter.  Certain  patients 
are  exceedingly  intolerant  of  belladonna  and  its  de- 
rivatives, a  fact  that  must  be  kept  in  mind,  especially 
when  using  the  alkaloid,  atropia.  Fatal  consequences 
are  very  rare,  but  uncomfortable  dryness  of  the  throat, 
dilatation  of  the  pupils,  and  some  degree  of  delirium 
are  not  uncommon.  At  the  same  time  it  must  be  ad- 
mitted that  in  many  instances  relief  from  suffering  is 
not  obtained  until  these  physiological  effects  of  the 
drug  have  been  manifested. 

Hyoscyamus. — As  might  be  inferred  from  their 
close  botanical  relationship,  hyoscyamus  and  bella- 
donna present  many  points  of  similarity.  Their  alka- 
loids are  almost  identical  in  chemical  and  physiologi- 
cal properties.  The  extract  of  belladonna  is  consider- 
ably stronger  than  the  extract  of  hyoscyamus.  Like 
other  solanaceous  plants,  this  is  powerfully  narcotic 
and  anodyne.  Sleep  is  produced  only  by  the  use  of 
the  drug  in  large  doses,  which  also  tend  to  excite  de- 
lirium, sometimes  even  reaching  to  the  height  of 
maniacal  fury.  Children  tolerate  hyoscyamus  in  doses 
proportionally  larger  than  can  be  taken  by  adults. 
By  many  physicians  it  is  considered  the  hypnotic  par 
excellence  for  children.  In  the  various  forms  of  insanity 
the  tranquilizing  influence  of  hyoscyamus  is  highly 
esteemed.  The  derivative  preparations,  hyoscyamine 
and  hyoscyamia,  are  preferable  for  use  in  this  class  of 
cases.  The  first  may  be  given  in  doses  of  1-16  —  1 
grain ;  the  latter  is  much  more  powerful,  and  should 
be  given  in  doses  not  exceeding  1-100  grain  until  the 
degree  of  its  tolerance  has  been  ascertained. 

Sframonium. — This  is   another  of  the  solanaceous 


STRAMONIUM  — PHOSPHORUS  — ACIDS.  71 

plants,  possessing  many  qualities  like  those  found  in 
belladonna.  It  is  not  directly  hypnotic.  Poisonous 
doses  produce  delirium  and  persistent  insomnia.  But 
its  anti-spasmodic  effect  upon  the  paroxysm  of  nervous 
asthma  renders  it  indirectly  hypnotic  in  that  affection. 
For  the  relief  of  bronchial  spasm  the  smoke  of  the 
dried  leaves  should  be  inhaled  in  considerable  quantity. 
It  may  be  smoked  in  a  pipe ;  or,  mixed  with  saltpetre, 
it  may  be  made  to  smoulder  upon  a  tin  plate,  while 
the  smoke  is  drawn  by  inspiration  into  the  lungs. 
Various  kinds  of  medicated  pastiles  have  been  pre- 
pared, to  effect  a  similar  result  by  furnishing  the  drug 
in  a  convenient  form  for  use.  Tobacco  and  lobelia 
operate  in  a  very  similar  manner  upon  all  spasmodic 
affections  of  the  respiratory  passages ;  but  their  energy 
is  almost  too  great  for  the  comfort  of  the  patient. 

Phosphorus. — Bartholow  has  recommended  this 
drug  in  "  cases  of  wakefulness  dependent  on  cerebral 
anaemia  and  exhaustion,"  and  in  "  the  wakefulness  of 
the  aged,  accompanied  with  muscular  cramps,  feeble- 
ness of  memory,  giddiness,  and  trembling  of  the 
voluntary  muscles  on  exertion."  In  minute  doses,  it 
is  true  that  phosphorus  acts  as  an  irritant  of  nervous 
tissue.  It  promotes  destructive  changes  in  the  tissues 
of  the  body,  and  thus  produces  a  temporary  excitement 
which  may  favor  the  processes  of  nutrition.  In- 
directly, it  may  thus  prove  beneficial  in  many  cases  of 
cerebral  exhaustion;  but  as  a  direct  hypnotic  it  will  be 
found  of  very  little  service.  It  should  be  given  in 
doses  of  1-100  grain  every  four  hours. 

Acids. — In  those  forms  of  sleeplessness  which  are 
dependent  upon  disordered  conditions  of  the  digestive 


72  INSOMNIA. 

apparatus,  acids  are  often  useful.  Their  topical  effects 
upon  the  mucous  membrane  of  the  stomach  are  stimu- 
lant and  alterative;  hence  they  are  useful  in  atonic 
dyspepsia,  where  there  is  deficient  secretion  of  the 
gastric  juice.  In  such  cases  hydrochloric  acid  and 
lactic  acid  are  useful.  The  first  should  be  given,  in 
doses  of  ^\ei  drops  diluted  with  half  a  pint  of  water, 
after  each  meal.  Lactic  acid  may  be  given  in  doses  of 
one  or  two  teaspoonfuls,  similarly  diluted.  It  has  been 
asserted,  on  theoretical  grounds,  that  lactic  acid  and 
the  lactate  of  sodium  are  directly  hypnotic,  but  its  ex- 
perimental use  has  never  given  satisfactory  results. 
Phosphoric  acid  has  been  used  in  the  same  way,  with 
very  similar  effects.  An  impure  solution  of  phos- 
phoric acid,  known  as  Horsford^s  Acid  Phosphate,  has 
been  extensively  used  for  its  supposed  hypnotic  prop- 
erties. It  assists  digestion,  stimulates  the  kidneys, 
and  by  its  general  diffusion  promotes  molecular  activity 
throughout  the  body.  It  is  thus  indirectly  beneficial 
in  cases  of  insomnia.  No  small  part  of  the  benefits 
thus  obtained  must,  however,  be  ascribed  to  the  water 
with  which  these  acids  are  diluted.  When  the  liver 
becomes  sluggish  in  its  action,  nitric  acid,  in  doses  of 
five  drops  diluted  with  half  a  pint  of  water,  may  be 
taken  every  four  hours  with  great  advantage.  Thus 
used,  the  mineral  acids  may  often  yield  invaluable  ser- 
vice in  the  treatment  of  insomnia  occasioned  by  cachectic 
conditions  of  the  body — notably  such  as  are  produced 
by  malaria,  oxaluria,  and  the  so-called  phosphatic  and 
rheumatic  diatheses. 


NERVOUS  SEDATIVES  —  COLD.  73 

NEEVOUS    SEDATIVES. 

The  remedies  thus  far  considered  are  but  indirectly 
hypnotic  in  their  effects,  though  exceedingly  valuable 
as  agents  for  the  production  of  conditions  favorable  to 
sleep.  We  may  now  pass  to  the  consideration  of  a 
class  of  remedies  which  operate  more  directly  upon 
the  brain  to  depress  its  energy.  They  are,  therefore, 
called  nervous  sedatives,  and  they  include  the  majority 
of  narcotic  substances. 

Cold. — The  operation  of  cold  upon  the  body  has 
already  been  sufficiently  considered.  It  only  remains 
to  note  the  effects  of  cold  applied  through  the  agency 
of  baths  and  local  refrigerants.  A  full  account  of  the 
theory  and  practice  of  hydrotherapeutics  can  be  found 
in  the  second  volume  of  Von  Ziemssen's  Handhuch  der 
Allgemeinen  Therapie.  The  English  reader  will  find 
the  subject  treated  at  sufficient  length  in  Einger's 
Handbook  of  Therapeutics. 

According  to  Ringer,  the  sitz-bath,  taken  at  a  tem- 
perature between  60°  and  80°  F.,  is  very  useful  to 
soothe  "  an  irritable  restless  state  of  the  nervous  sys- 
tem." It  should  be  employed  once  or  twice  a  day, 
from  five  to  thirty  minutes  at  a  time.  Among  other 
beneficial  consequences  is  the  promotion  of  quiet  sleep. 

For  the  relief  of  the  pungent  heat  and  restlessness 
which  add  so  much  to  the  danger  of  the  specific  fevers 
cold  baths  have  been  highly  recommended.  These 
have  been  employed  with  great  energy  in  many  of  the 
German  hospitals ;  and  often  with  great  benefit  to  the 
patient.  The  preferable  method  is  the  one  advised  by 
Von  Ziemssen  and  Immerman.     The  patient  is  placed 


74  INSOMNIA. 

in  a  tub  of  water  at  95°  F.  This  is  very  gradually 
cooled  down,  in  the  course  of  half  an  hour,  to  60''  F. 
The  bath  should  be  repeated  from  three  to  five  times  a 
day.  according  to  the  temperature  of  the  patient.  By 
this  method  of  treatment  the  patient  is  made  more 
comfortable;  he  becomes  less  restless  or  delirious,  and 
secures  a  larger  amount  of  refreshing  sleep. 

The  difficulty  of  administering  such  a  laborious 
course  of  baths  outside  of  a  well  equipped  hospital 
renders  its  adoption  almost  impossible  in  private  prac- 
tice. Here  the  physician  must  rely  upon  assiduous 
sponging  with  water  of  an  agreeable  temperature.  In 
severe  cases,  such  as  measles  before  the  appearance  of 
the  eruption,  scarlet  fever  during  the  period  of  heat 
and  agitation,  and  typhoid  fever  during  the  correspond- 
ing stage,  great  benefit  will  be  derived  from  the  cold 
wet  sheet.  In  order  to  humor  the  prejudices  of  the 
laity,  this  should  be  wrung  out  of  warm  water,  and 
applied  with  sufficient  deliberation  to  insure  its  con- 
siderable loss  of  heat.  A  blanket  should  first  be 
spread  upon  an  empty  bed;  the  wet  sheet  should  be 
spread  over  the  blanket.  The  patient  must  be  placed 
naked  upon  the  sheet,  which  should  then  be  drawn 
around  the  entire  body,  and  the  blanket  may  be  folded 
around  the  whole  package.  Children  generally  insist 
upon  leaving  their  arms  uncovered.  This  may  be 
allowed  with  safety  in  many  cases,  but  generally  a  wet 
napkin  should  cover  the  upper  part  of  the  chest  and 
the  neck  which  cannot  be  reached  with  the  sheet  when 
the  arms  are  exposed.  After  remaining  from  half  an 
hour  to  two  hours  in  the  pack,  the  patient  becomes 
comparatively  cool  and  quiet,  and  the  eruption,  if  de- 


COLD   BATHS  —  ANESTHETICS.  75 

layecl,  begins  to  appear.  Sleep  often  occurs  as  an 
immediate  consequence  of  the  relief  thus  obtained. 

Similar  good  results  may  be  secured  by  the  use  of 
cold  affusion  in  cases  of  high  temperature  and  great 
restlessness.  I  well  remember  a  little  boy,  about  eight 
years  old,  whom  I  once  found  rolling  and  tossing  and 
burning  up  with  scarlet  fever.  Calling  for  an  empty 
wash-tub,  I  had  him  stripped  and  placed  upright  in 
the  tub.  I  then  began  to  pour  cold  water  over  him 
from  a  large  pitcher.  Scaicely  had  the  water  touched 
his  skin,  before  he  seized  the  pitcher,  and  began  to 
drink  from  it.  He  was  permitted  to  completely  slake 
his  thirst,  and  then  the  affusion  was  resumed.  After 
f oui'  or  five  gallons  of  water  had  been  thus  poured  over 
him,  he  was  wiped  dry,  and  was  returned  to  his  bed, 
where  he  immediately  turned  upon  his  side,  and  fell 
into  a  peaceful  sleep.  A  few  more  affusions  relieved 
him  from  danger,  and  he  made  a  rapid  recovery. 
Were  people  less  afraid  of  such  measures,  a  consider- 
able portion  of  the  danger  in  fevers  might  be  obviated. 
Great  discretion,  however,  is  necessary  in  the  applica- 
tion of  such  treatment,  for  Ringer  states  that  he  has 
"  seen  a  child,  suffering  from  scarlet  fever,  killed  by 
an  over-energetic  employment  of  cold."  The  tempera- 
ture of  the  patient  should  be  carefully  noted,  and  its 
reduction  below  the  normal  standard  should  never 
be  permitted. 

Ancesiheiics.  —  All  anaesthetics  are  hypnotics.  In 
other  words,  they  possess  the  power  to  abolish  con- 
sciousness, and  thus  to  produce  a  condition  resembling 
sleep.  This  is  effected  by  the  direct  action  of  the  an- 
aesthetic substance  upon  the  cellular  structure  of  the 


76  INSOMNIA. 

brain,  reducing  the  molecular  movements  of  the  living 
protoplasm  below  the  degree  requisite  for  the  ex- 
citement of  consciousness.  This  sedative  effect  is 
preceded  by  a  brief  period  of  cerebral  exaltation,  occa- 
sioned by  the  disturbances  caused  by  the  first  intro- 
duction of  the  drug  into  the  current  of  the  circulation. ' 
It  is  with  the  subsequent  hypnotic  effect  only  that  we 
are  now  concerned.  Of  the  numerous  anaesthetic  sub-, 
stances  that  have  been  discovered,  but  few  compara- 
tively have  been  found  sufficiently  manageable  and 
safe  for  general  use.  These  are  alcohol,  paraldehyde, 
ether,  compound  spirits  of  ether,  chloroform,  chloral, 
butylic  chloral,  and  amylic  nitrite. 

Alcohol. — The  hypnotic  effect  of  alcoholic  drinks  is 
very  decided,  though  not  speedily  manifested  unless 
the  beverage  be  taken  in  considerable  quantity.  Dis- 
tilled liquors  produce  the  effect  of  alcohol  in  its  sim- 
plest form;  wines,  containing  various  forms  of  ether, 
arouse  the  nervous  system  more  thoroughly  and  agree- 
ably than  the  pure  alcoholic  stimulants.  Beer  and 
porter  are  rendered  more  powerfully  narcotic  by  the 
active  principle  of  hops  which  they  contain.  The 
nutritive  substances  held  in  solution  by  these  last  ren- 
der them  peculiarly  appropriate  in  cases  that  require 
nourishment  as  well  as  rest.  The  considerable  quan- 
tity in  which  they  must  be  taken,  renders  them  incon- 
venient for  use  in  cases  of  severe  illness.  Wines  and 
distilled  liquors  are  then  most  available. 

Alcohol  is  principally  useful  as  an  hypnotic  when 
wakefulness  is  associated  with  great  bodily  exhaustion, 

^  Artijicial  Aticesthesia  and  Anasthetics,  pp.  20-28.  William  Wood 
&  Co.,  New  York,  1881. 


ALCOHOL.  77 

such  as  may  be  experienced  in  advanced  stages  of  the 
infective  fevers.  In  such  cases  the  heart  is  weak- 
ened, the  pulse  is  rapid  and  feeble,  the  muscular  appa- 
ratus is  wasted  and  irritable,  the  blood  is  diminished 
in  volume  and  tends  to  accumulate  in  the  venous 
channels.  Under  such  conditions  the  patient  is  usu- 
ally delirious,  tossing  from  side  to  side,  and  quite  de- 
prived of  sleep.  An  ounce  of  brandy,  repeated  at 
intervals  varying  according  to  the  severity  of  the 
symptoms,  and  given  with  milk  and  egg,  in  the  famil- 
iar form  of  eggnogg,  will  often  quiet  this  harassing 
restlessness,  and  will  procure  refreshing  sleep.  The 
temperature  of  the  patient  will  then  decline;  the 
tongue  will  grow  moist;  and  the  delirium  will  dimin- 
ish or  subside  altogether.  Sometimes,  however,  a  con- 
trary result  is  observed.  Alcohol  should  then  be 
administered  with  a  sparing  hand,  and  it  will  proba- 
bly be  necessary  to  resort  to  the  bromides  or  other 
cerebral    sedatives. 

The  great  exhaustion  which  is  manifested  in  delir- 
ium tremens  sometimes  requires  the  use  of  alcohol  to 
support  the  patient,  so  that  sleep  may  be  procured.  It 
is  in  such  cases  advisable  to  combine  the  administra- 
tion of  capsicum  with  that  of  alcohol.  According  to 
Einger,  capsicum  should  be  given  for  this  purpose  in 
scruple  doses,  made  into  a  bolus  with  honey,  and 
repeated  every  three  hours. 

Wakefulness  caused  by  neuralgic  pains  is  speedily 
relieved  by  full  doses  of  alcohol.  The  various  species 
of  abdominal  and  pelvic  neuralgia  may  thus  be  tem- 
porarily suspended.  In  like  manner  the  "  rheumatic  " 
pains  which  afflict  the  overworked  and  underfed  poor 


78  INSOMNIA. 

may  be  calmed  for  a  season  sufficient  to  procure  sleep. 
The  obvious  dangers  attendant  upon  such  medication, 
however,  need  no  comment. 

Old  people  not  unfrequently  suffer  with  a  form  of 
insomnia  that  is  associated  with  feeble  and  painful 
digestion.  This  is  probably  caused  by  insufficient 
erastro-intestinal  secretion.  The  use  of  wine  contain- 
ing  a  large  proportion  of  compound  ethers  gives  relief 
through  the  improvement  in  digestion  consequent  upon 
the  stimulant  effect  of  small  doses  of  alcohol  and 
ether.  Under  their  influence  the  digestive  fluids  are 
more  abundantly  secreted,  and  all  the  bodily  functions 
are  quickened.  Such  good  results,  however,  only  fol- 
low the  moderate  use  of  the  stimulant.  It  must  never 
be  taken  in  quantity  sufficient  to  affect  the  intellectual 
functions,  or  to  disturb  any  of  the  normal  processes  of 
life.  The  best  results,  so  far  as  digestion  is  concerned, 
are  obtained  by  the  use  of  wine  with  the  meals ;  but  a 
night-cap,  in  the  form  of  hot  toddy,  is  sometimes  nec- 
essary in  addition.  This  is  especially  useful  if  there 
be  any  form  of  irritative  cough  or  local  excitement, 
such  as  the  aged  sometimes  experience. 

The  insomnia  that  attends  excessive  fatigue  may  be 
very  quickly  relieved  by  the  use  of  food  and  alcohol.  For 
this  purpose  any  form  of  alcoholic  drink  will  be  found 
useful.  The  quantity  administered  should  only  be 
sufficient  to  produce  a  uniform  and  general  vascular 
relaxation.  By  this  means  the  circulation  is  equalized 
throughout  the  body,  and  the  brain  passes  into  a  state 
of  tranquil  sleep.  Any  excess  in  the  use  of  alcohol 
under  such  conditions  will  be  followed  by  headache 
and   discomfort  on   awaking.     In  all  cases  the  intoxi- 


PARALDEHYDE.  79 

eating  dose  of  alcohol   must  be  avoided,  if  its  truly 
hypnotic  effect  be  desired. 

Paraldehyde. — This  is  a  derivative  from  ethyl  alco- 
hol. It  is,  when  pure,  a  colorless  liquid,  with  an 
agreeable  odor,  somewhat  like  that  of  ether.  It  is  sol- 
uble in  the  proportion  of  one  part  in  eight  or  nine  of 
water.  It  may  be  used  internally  in  doses  varying 
from  forty-five  to  one  hundred  and  sixty  grains.  A 
watery  solution,  containing  one  part  to  ten,  has  been 
recommended  for  internal  administration.  It  may  also 
be  given  in  milk  or  in  beer.  M.  Yvon^  recommends  the 
following  formula: 

Paraldehyde,  -         -         -         Gr.  20.0 

Spirit,          .  -         -         _           100.0 

Syr.  SimpL,  -         -         _         -        75.0 

Tr.  Vanilla,  .         -         _               5.0 

An  ounce  of  this  mixture  contains  forty-five  grains 
of  paraldehyde.  When  taken  it  should  be  still  further 
diluted  with  sweetened  water,  or  with  beer,  to  obviate, 
as  far  as  possible,  the  disagreeable  taste  of  the  drug. 
Sleep  follows  after  the  lapse  of  about  half  an  hour,  and 
continues  from  five  to  seven  hours.  The  physiological 
action  of  the  medicine  is  very  similar  to  that  of  chlo- 
ral hydrate,  and  its  use  is  indicated  in  the  same  class 
of  cases  to  which  that  drug  is  appropriate.  By  many 
it  is  considered  the  preferable  hypnotic.  It  has  found 
considerable  employment  in  the  insane  asylums  of 
Europe,  and  in  other  institutions  where  disagreeable 
medication  is  no  obstacle  to  experiment.      In   private 

^  Bull.  gen.  de  Tk&ap.,  1884,  2°  Livr. 


80  INSOMNIA. 

practice  the  peculiar  taste  and  smell  of  the  article,  and 
its  pungent  effect  upon  the  mucous  membranes  of  the 
alimentary  canal,  render  its  exhibition  more  difficult. 
But  the  weight  of  testimony  is  in  its  favor  as  an  hyp- 
notic in  all  cases,  uncomplicated  with  disease  of  the 
stomach,  in  which  insomnia  is  not  dependent  upon 
pain,  and  is  associated  with  cerebral  hypersemia.  Its 
administration  is  followed  by  no  unpleasant  conse- 
quences. Among  the  insane  it  is  particularly  recom- 
mended during  periods  of  excitement  and  wakefulness. 
It  has  been  employed  with  great  satisfaction'  in  cases 
of  insomnia  during  the  course  of  such  varied  diseases 
as  emphysema,  bronchitis,  phthisis,  nervous  and  spinal 
disorders,  diseases  of  the  heart,  jaundice,  chronic 
rheumatism,  and  insomnia  from  other  unrecognized 
causes.  Undoubtedly,  with  greater  skill  in  its  purifi- 
cation and  exhibition,  it  will  become  one  of  the  most 
valuable  of  hypnotic  remedies.  Almost  useless  for  the 
relief  of  pain,  it  is  indicated  in  cases  of  uncomplicated 
insomnia.  Having  very  little  power,  in  moderate 
doses,  to  depress  the  action  of  the  heart,  it  is  prefera- 
ble to  chloral  hydrate  in  cardiac  diseases  and  debility. 
Sleep  procured  with  doses  of  fifteen  to  sixty  grains  is 
calm  and  refreshing,  and  is  not  followed  by  any  disa- 
greeable consequence.  A  certain  degree  of  tolerance 
is  gradually  established,  so  that  larger  doses  may  be- 
come necessary.  It  has  been  given  in  quantities 
amounting  to  three  drachms;  but,  if  large  doses  be 
given  before  the  development  of  tolerance,  the  patient 
will  experience  headache,  uneasiness,  nausea,  and  vom- 
iting, after  waking  from  the  sleep  thus  induced.     An- 

^  Centralblatt  fiir  klin.  med.,  1884.      Nr.  12. 


ETHER  — CHLOROFORM.  81 

other  advantage  possessed  by  paraldehyde  consists  in  the 
absence  of  the  period  of  excitement  produced  by  chlo- 
ral before  the  advent  of  sleep.  It  is  an  hypnotic,  with- 
out narcotic  properties,  limiting  its  effects  chiefly  to 
the  brain,  and  leaving  the  spinal  cord  in  a  condition 
nearly  like  that  of  natural  sleep. 

Ether,  though  possessed  of  the  greatest  value  as  an 
agent  for  the  production  of  artificial  ansesthesia,  is 
rarely  used  as  a  mere  hypnotic.  Diluted  with  alcohol 
and  ethereal  oil,  it  forms  the  Compomid  Spirit  of 
Ether,  or  Hoffmcmn's  Anodyne.  In  this  form  it  is 
well  adapted  for  internal  administration.  It  is  thus 
very  serviceable  in  the  treatment  of  those  forms  of  in- 
somnia associated  with  nervous  irritability  and  hysteria. 
For  the  relief  of  wakefulness  dependent  upon  a  languid 
circulation,  with  cold  feet  and  flatulence,  the  anodyne 
may  be  given  in  half-drachm  doses  well  diluted  with 
ice  water,  and  repeated  every  fifteen  minutes  till  relief 
is  obtained.  Nearly  all  forms  of  painful  or  spasmodic 
^disturbance  unattended  by  fever  may  be  thus  relieved. 
For  this  reason  it  is  particularly  useful  in  the  treat- 
ment of  uterine  colic  and  in  sleeplessness  after  child- 
birth, when  opiates  cannot  be  tolerated,  or  are  contra- 
indicated  on  account  of  their  tendency  to  excite  the 
brain. 

Chloroform,  like  ether,  is  an  agent  too  powerful 
and  too  evanescent  for  use  as  a  simple  hypnotic.  But 
for  the  relief  of  intense  suffering  caused  by  nervous 
irritation  and  spasm  it  is  without  any  superior.  In 
certain  minor  affections  of  a  spasmodic  character  it, 
therefore,  forms  a  valuable  adjuvant  to  other  remedies. 
Diluted  with  alcohol  it  forms  the  spirit  of  chloroform, 
6 


82  INSOMNIA. 

a  remedy  which  is  useful  in  all  cases  for  which  the  com- 
pound spirit  of  ether  is  usually  prescribed.  In  this  form 
it  is  an  excellent  addition  to  various  mixtures  designed 
for  the  relief  of  spasmodic  coughs  by  which  sleep  is 
disturbed.  Kinger  recommends  it  in  the  treatment  of 
the  irritative  cough  so  characteristic  of  fibroid  phthisis. 
It  should  also  be  used  in  cases  of  spasmodic  asthma. 
The  asthmatic  paroxysm  may  frequently  be  arrested 
by  inhalations  of  the  vapor  of  chloroform  or  ether; 
but,  unfortunately,  the  lungs  soon  become  tolerant  of 
these  agents,  and  they  then  cease  to  afford  relief.  The 
valuable  mixture  known  by  the  name  chlorodyne  owes 
a  considerable  portion  of  its  efficacy  to  the  presence  of 
chloroform  as  one  of  its  ingredients. 

Chloral. — Until  the  recent  introduction  of  paralde- 
hyde, chloral  hydrate  has  for  many  years  held  the  first 
rank  as  an  hypnotic.  It  is  particularly  useful  in  wake- 
fulness occasioned  by  exhaustion  of  the  nervous  cen- 
tres. The  conclusions  of  all  experienced  observers 
have  been  most  concisely  stated  as  follows: '  "Chloral 
appears  to  be  indicated  when  sleeplessness  is  depend- 
ent upon  a  vascularity  due  to  exhaustion  rather  than 
to  primary  excitement  of  the  brain ;  thus  it  has  been 
found  useful  when  loss  of  sleep  follows  severe  and 
prolonged  mental  application  or  excitement  of  feeling, 
or  accompanies  the  general  debility  following  acute 
diseases  attended  with  delirium  or  severe  pain,  or  is 
associated  with  acute  mania^  especially  of  the  puerperal 
form.  The  somewhat  analogous  condition  which  exists 
in  delirium  iremens  is  very  amenable  to  this  medicine, 
especially  in  the  forming  stage  of  the  affection  known 

'  The  National  Dispensatory,  1884,  p.  433. 


CHLORAL  —  BUTYLCHLORAL.  «3 

as  *the  horrors,'  and  which  so  frequently  follows  sur- 
gical injuries  in  drunkards ;  it  is  useful  eIqo  when  great 
nervous  excitement  and  restlessness  are  associated  with 
extravagant  phantasms.  Nevertheless,  its  depressing 
effects  are  to  be  guarded  against  in  this  affection  as  in 
the  different  forms  of  insanity."  This  caution  is 
directed  against  the  frequent  and  repeated  employment 
of  the  article  in  chronic  cases,  on  account  of  the  vaso- 
motor paralysis  and  general  cachexia  thus  induced.  It 
is  now  claimed  that  many  of  these  consequences  may 
be  avoided  by  the  substitution  of  paraldehyde  in  the 
place  of  chloral,  but  it  has  been  shown  ^  that  similar 
effects  may  follow  the  long  continued  use  of  this  sub- 
stitute. 

Chloral  is  usually  administered  by  the  mouth  in 
doses,  for  adults,  of  twenty  to  thirty  grains,  dissolved 
in  sweetened  peppermint  water.  If  the  first  dose  does 
not  procure  sleep,  it  may  be  followed  at  the  expiration 
of  an  hour  by  a  second  dose  of  twenty  grains.  This 
seldom  fails  to  induce  refreshing  sleep.  When  the 
medicine  cannot  be  tolerated  by  the  stomach  it  may  be 
given  by  enema  in  milk.  For  this  purpose  a  drachm 
of  chloral  should  be  suspended  with  the  white  of  an 
egg  in  half  a  teacupful  of  milk. 

ButylcMoral  hydrate. — This  substance  has  been 
recommended  as  a  substitute  for  chloral  hydrate,  in 
cases  of  cardiac  weakness,  on  account  of  its  being  less 
powerful  to  depress  the  action  of  the  heart.  It  is 
principally  useful  for  the  relief  of  facial  neuralgia  and 
hemicrania.  As  an  hypnotic  it  is  seldom  used.  For 
this  purpose  it  may  be  given  in  a  solution  like  that  of 

"^Deutsche  Med.  wochenschr. ,\'^%2)i  ^r.  49. 


84  INSOMNIA. 

chloral  hydrate.  For  a  simple  anodyne  effect  the 
medicine  may  be  given  in  five-grain  doses,  repeated 
every  half  hour  or  hour.  As  a  means  of  procuring 
sleep  it  may  be  given  in  doses  ranging  from  fifteen  to 
forty-five  grains.  Liebreich  has  given  the  medicine 
in  drachm  doses,  and  recommended  it  as  an  hypnotic 
superior  to  chloral  hydrate.  It  is  useful  in  the  sleep- 
lessness of  headaches,  neuralgia,  dysmenorrhoea,  and 
chronic  phthisis. 

Amyl  nitrite. — This  drug  has  been  recommended 
for  the  relief  of  insomnia  resulting  from  the  opium 
habit.  Ringer  considers  it  useful  in  the  flushes  of 
heat  and  other  forms  of  discomfort  which  sometimes 
interfere  with  the  sleep  of  women  during  the  change 
of  life.  It  should  be  inhaled  in  the  form  of  vapor, 
from  a  handkerchief  upon  which  five  drops  have  been 
poured.  The  quantity  will  need  to  be  gradually  in- 
creased, as  the  system  becomes  tolerant  of  its  effects. 
The  stimulant  effect  of  the  medicine  renders  its  use  in 
this  manner  probably  less  dangerous  than  the  similar 
employment  of  chloroform.  Unlike  the  other  anaes- 
thetics above  mentioned,  it  causes  a  hypersemic  condi- 
tion of  the  brain,  and  is,  for  this  reason,  a  useful 
hypnotic  in  cases  of  aortic  obstruction  with  an  insuf- 
ficient cerebral  circulation  and  consequent  wakeful- 
ness. 

Opium  and  opiates. — There  seems  to  be  no  agree- 
ment among  experimental  physiologists  regarding  the 
manner  in  which  opium  produces  its  effects  upon  the 
body.  By  some  it  is  ranked  as  a  stimulant;  by  others 
it  is  considered  a  sedative.  These  different  opinions 
are  probably  due  on  the  one  hand  to  differences  in  the 


OPIUM   AND   OPIATES.  85 

dose  and  strength  of  the  opiates  employed,  and  on  the 
other  to  idiosyncrasies  on  the  part  of  the  individuals 
subjected  to  experiment.  The  soporific  effect  of  the 
drug  appears  to  result  from  its  direct  action  upon  the 
substance  of  the  brain.  Under  its  influence  the  blood 
tends  to  accumulate  in  the  veins,  and  loses  its  bright 
arterial  hue.  Small  doses  are  said  to  contract  the 
capillaries  of  the  body,  while  they  are  dilated  by  exces- 
sive doses  of  the  drug.  From  this  it  may  be  inferred 
that  opium  acts,  like  many  other  narcotics,  as  an  irri- 
tant of  the  tissues  when  given  in  minute  quantity,  and 
as  a  paralyzing  agent  when  a  certain  relative  amount 
is  exceeded.  The  experiments  of  Curci  ^  indicate  that 
under  the  influence  of  irritating  doses  of  morphia  the 
brain  becomes  hypersemic. 

Opium  is  a  remarkably  complex  substance,  no  less 
than  nineteen  different  alkaloids  having  been  separated 
from  it.  Of  these,  however,  only  one  has  stood  the 
test  of  therapeutical  experiment — morphia.  Several 
other  constituent  alkaloids,  notably  codeia,  have  been 
lauded  as  hypnotics,  but  they  are,  at  their  best,  far 
inferior  to  morphia,  and  may  well  be  omitted  from  the 
list  of  sleep  producers.  But,  though  the  soporific 
properties  of  opium  are  chiefly  due  to  the  morphia 
which  it  contains,  there  are  certain  points  of  difference 
between  the  action  of  the  two  medicines  that  often 
render  a  choice  desirable.  According  to  Stille  and 
Maisch,^  morphia  does  not  stimulate  circulation  and 
the  nervous  system  as  much  as  opium,  and  its  narcotic 
effects  are  less  decided  and  speedy,  though  its  after 

^  Lo  Sperimentale ,  April,  1884. 

^  The  National  Dispensatory ,  1884,  p.  993. 


86  INSOMNIA. 

effects  are  more  enduring.  Opium  increases  the  bodily- 
temperature  and  sense  of  heat;  morphia  produces  the 
last  effect,  but  diminishes  the  temperature.  Opium  at 
first  increases  the  frequency  of  the  pulse,  while 
morphia  diminishes  it.  Opium  is  of  the  two  the  less 
liable  to  excite  nausea  and  vomiting;  hence  the  supe- 
riority of  the  tinctures  and  aqueous  solutions  of  opium 
when  nausea  is  specially  feared. 

Of  all  the  remedies  for  the  relief  of  pain  opiates 
are  the  most  effectual.  Before  the  introduction  of  the 
alcoholic  hypnotics  and  the  bromides,  they  constituted 
the  principal  agents  in  the  treatment  of  insomnia. 
Even  at  the  present  time  they  are  indispensable  for 
the  relief  of  all  forms  of  sleeplessness  dependent  upon 
pain.  A  combination  of  chloral  hydrate,  sodium 
bromide,  and  morphine  forms  one  of  the  most  gen- 
erally useful  hypnotic  compounds  ever  employed. 

Under  ordinary  circumstances  morphia  is  the 
preferable  opiate  for  the  relief  of  insomnia.  The  sul- 
phate is  most  frequently  employed,  but  the  acetate  and 
the  tartrate  have  been  recommended  on  account  of  their 
supposed  superiority  in  the  formation  of  solutions  that 
are  unirritating  and  permanent  in  their  character.  The 
hypodermic  method  of  administration  forms  the  most 
prompt  and  efficient  mode  of  procuring  the  effect  of 
the  medicine.  It  should  be  given  in  a  dose  of  quarter 
of  a  grain  about  an  hour  before  the  time  when  sleep  is 
desired.  For  some  patients  a  longer  time  is  necessary 
to  develop  its  hypnotic  effect.  To  children  the 
hypnotic  dose  must  sometimes  be  given  at  three  o'clock 
in  the  afternoon  in  order  to  induce  sleep  at  nine  o'clock 
in  the   evening.     As  the   effect  of  opiates  is  highly 


OPIUM   AND   OPIATES.  8< 

stimulant  to  the  sweat-glands,  and  is  often  productive 
of  nausea,  it  is  advisable  to  associate  atropine  with 
morphine  when  thus  given.  For  an  adult  the  hun- 
dredth of  a  grain  of  atropine  may  be  given  with  every 
quarter  of  a  grain  of  morphine.  The  soothing  and 
agreeable  effects  of  morphia  are  thus  intensified,  while 
its  disagreeable  tendencies  are  reduced  to  a  minimum. 
The  injection  should  be  made  into  the  loose  areolar 
tissue  between  the  skin  and  the  muscles.  Its  location 
is  a  matter  of  little  importance  so  far  as  the  relief  of 
pain  is  concerned;  but  the  neighborhood  of  the  blood 
vessels  should  be  avoided,  since  alarming  symptoms 
have  been  observed  after  injection  into  a  vein.  The 
outer  aspect  of  the  arm  near  the  insertion  of  the  deltoid 
muscle  is  a  favorite  site  for  puncture.  If,  for  any 
reason,  the  hypodermic  use  of  morphia  cannot  be 
employed,  it  may  be  introduced  into  the  rectum  either 
in  solution  or  in  a  suppository.  The  bowel  should  first 
be  washed  out  with  an  enema  of  warm  water ;  the  opiate 
may  then  be  introduced.  The  dose  thus  exhibited 
need  scarcely  exceed  that  usually  given  by  the  mouth; 
but,  if  the  rectum  is  not  previously  cleansed,  a  double, 
or  even  triple,  dose  may  be  required. 

As  an  hypnotic  morphia  is  chiefly  useful  in  phthisis, 
in  cardiac  dyspnoea,  in  diseases  of  the  stomach  which 
cause  insomnia,  in  fevers  with  prostration  and  delirium, 
in  delirium  tremens,  in  mania,  and  in  the  majority  of 
painful  or  spasmodic  diseases.  If  the  patient  be 
violently  excited,  the  opiate  should  be  combined  with 
small  doses  of  tartar  emetic,  ipecac,  or  tincture  of 
aconite.  But  in  the  chronic  diseases  it  is  desirable  to 
avoid  its  continuous  administration,  not  only  on  account 


88  INSOMNIA. 

of  the  risk  of  creating  the  opium  habit,  but  also  by- 
reason  of  the  injurious  effects  of  the  drug  upon  diges- 
tion and  nutrition. 

Codeine  is  a  mild  hypnotic  which  may  be  used  in 
doses  about  twice  as  large  as  those  of  morphine.  It  is 
expensive  and  not  very  efficient,  but  may  be  sometimes 
prescribed  with  advantage  when  moral  considerations 
render  the  use  of  ordinary  opiates  inexpedient. 

Lactucarium  may  be  classed  with  the  weaker 
opiates.  It  possesses  very  little  value.  Its  fluid  ex- 
tract is  sometimes  prescribed  at  night  to  allay  the 
cough  of  pulmonary  consumption,  so  as  to  favor  sleep. 

Bromides. — According  to  Mitchell,  Echeverria,  and 
Bartholow,  the  soporific  energy  of  the  bromides  may 
be  ranked  as  follows:  Lithium  bromide  first,  sodium 
bromide  second,  potassium  bromide  third.  Hammond 
praises  calcium  bromide.  Hydrobromic  acid  is  also 
employed  as  an  hypnotic  in  certain  cases.  As  a  clinical 
fact  the  bromides  of  sodium  and  potassium  are  most 
frequently  employed  for  the  relief  of  insomnia.  Of 
these  the  second  is  most  useful  when  sleeplessness  is 
associated  with  the  phenomena  of  irritability;  the  first 
is  less  energetic  in  its  effects  upon  the  motor  structures 
of  the  body. 

The  bromides  act  upon  the  protoplasmic  constitu- 
ents of  the  body,  directly  inhibiting  their  functional 
energy.  Upon  the  spinal  cord  they  act  to  diminish 
reflex  excitability.  Under  their  influence  the  recep- 
tivity and  functional  capacity  of  the  brain  is  reduced. 
The  minute  blood  vessels  contract  in  consequence  of 
the  inactivity  of  the  tissues  Avhich  they  supply.  A 
lethargic  sleep  is  thus  induced. 


BROMIDES.  89 

For  the  reasons  above  stated  the  bromides  find  their 
greatest  opportunity  for  usefulness  in  cases  of  over- 
excitement  and  exhaustion  of  the  brain.  When  the 
cortical  cells  have  degenerated  into  a  condition  of 
irritable  weakness,  characterized  by  inordinate  insta- 
bility of  substance,  the  bromides  serve  to  steady  the 
fabric  by  retarding  those  movements  of  disintegration 
which  produce  morbid  wakefulness.  Almost  useless  in 
cases  marked  by  active  congestion  of  the  brain,  they 
are  invaluable  in  the  insomnia  produced  by  excessive 
mental  exertion,  care,  emotion,  worry  and  fatigue. 
The  wakefulness  of  hysteria,  of  asthenic  mania,  and  of 
sexual  excitement,  is  often  greatly  relieved  by  the  ad- 
ministration of  the  bromides.  The  prodromic  stage  of 
delirium  tremens,  before  any  violent  outbreak,  and  the 
wakefulness  of  convalescence  from  acute  diseases  are 
often  cured  by  their  use.  Mental  disturbances  and 
morbid  impulses  associated  with  pregnancy  or  the 
puerperal  state  may  be  dispelled  in  the  same  way. 
The  screaming  fits  of  night  terrors  in  children  are 
benefitted  by  these  medicines.  They  seem  to  increase 
the  efficacy  of  chloral,  chloroform,  ether,  cannabis 
indica,  hyoscyamus,  belladonna,  and  the  opiates. 

The  hypnotic  dose  of  hydrobromic  acid  is  twenty- 
five  grains,  largely  diluted  with  sweetened  water.  For 
this  reason,  and  for  its  disagreeable  taste,  it  is  not  an 
eligible  preparation.  Lithium  and  calcium  bromides 
may  be  given  in  scruple  doses  every  hour  or  two  till 
sleep  is  produced.  Sodium  and  potassium  bromides 
should  be  given  in  doses  of  thirty  or  forty  grains  every 
two  hours. 

It  is  sometimes  remarked  that  instead  of  favoring 


90  INSOMNIA. 

sleep  the  bromides  only  increase  wakefulness.  In  such 
cases  opiates  and  alcoholic  stimulants  are  usually  in- 
dicated. 

Hops. — The  principal  sedative  constituent  of  this 
plant  is  the  yellow  glandular  powder  found  in  the 
strobiles ;  this  is  called  lupitUn.  Hops  do  not  ^hibit 
any  directly  narcotic  property;  but  they  serve  to  allay 
nervous  excitement,  and  thus  favor  the  occurrence  of 
sleep.  They  are  principally  useful  in  cases  of  irrita- 
bility of  the  bladder  and  sexual  organs;  in  dyspepsia 
caused  by  irritable  weakness  of  the  stomach;  and  in 
the  exhaustion  of  delirium  tremens.  The  infusion  is 
the  best  preparation  for  internal  use.  It  may  be  taken 
in  doses  of  one  or  two  ounces,  as  required.  Lupulin 
may  be  given  in  doses  of  ten  grains  or  more.  Its  fluid 
extract  is  prescribed,  fifteen  or  twenty  minims  in  sweet- 
ened water  whenever  needed.  The  best  method,  how- 
ever, of  securing  the  beneficial  effects  of  the  medicine 
consists  in  the  administration  of  a  mild  beer  that  is  rich 
in  hops.  A  glass  at  bedtime  often  forms  a  sufficient 
hypnotic. 

Gelsemium  is  a  very  powerful  agent  for  depressing 
the  pulse  and  the  functional  activity  of  the  spinal  cord. 
It  thus  favors  the  induction  of  sleep  in  cases  attended 
with  violent  excitement,  such  as  may  be  witnessed  in 
acute  mania.  It  has  been  employed  in  the  treatment 
of  delirium  tremens ;  but  the  poisonous  qualities  of  the 
plant  render  its  use  somewhat  dangerous.  The  toxic 
effects  are  sometimes  developed  quite  suddenly,  and  in 
a  manner  very  alarming  to  the  laity.  For  these 
reasons    it    is  not  to  be  recommended  as  a  soporific, 


CONIUM.  91 

unless  the  patient  can  be  continually  under  the  eye  of 
the  physician  or  of  an  intelligent  nurse. 

Conium  has  been  found  useful  in  the  insomnia  of 
mania,  not  through  any  narcotic  property  of  its  own, 
but  by  reason  of  its  sedative  effects  upon  the  spinal 
cord  and  nerves.  Under  its  influence  the  excitement 
of  the  patient  is  so  far  reduced  that  other  hypnotic 
remedies  can  produce  their  effect.  For  this  purpose 
Squibb' s  fluid  extract,  in  doses  of  about  one-third  of  a 
ch'achm,  or  one-sixtieth  of  a  grain  of  coniine,  may  be 
given  sufficiently  often  to  repress  excitement.  The 
alkaloid  may  be  given  hypodermically,  and  in  gradu- 
ally increasing  doses.  With  it  should  be  associated 
other  remedies,  like  hyoscyamus  and  chloral  hydrate, 
in  order  to  procure  sleep.  ^ 

*  Kiernan,  Joiirn,  Nerv.  and  Mental  Diseases,  Vol.  X,  p.  234 


CHAPTEK  IV. 

TBEATMENT  OF  INSOMNIA  IN  PARTICULAR  DISEASES. 

Take  thou  this  phial,  being  then  in  bed, 

And  this  distilled  liquor  drink  thou  off; 

When  presently,  through  all  thy  veins  shall  run 

A  cold  and  drowsy  humor,  which  shall  seize 

Each  vital  spirit. 

— Romeo  and  Jttliet. 

Excluding  from  consideration  all  cases  of  insomnia 
arising  from  painful  injuries  or  diseases  of  the  external 
portions  of  the  body,  which  belong  to  the  province  of 
surgical  therapeutics,  we  may  profitably  commence 
with  the  variety  of  wakefulness  that  is  excited  by  dis- 
order of  the  brain  and  its  membranes.  This  includes 
the  difPerent  forms  of  meningitis,  the  cerebral  disturb- 
ances which  constitute  insanity,  cerebral  exhaustion, 
and  chronic  alcoholism. 

Insomnia  in  acute  affections  of  the  brain. — Acute 
intra-cranial  inflammations  may  result  from  general 
diseases,  like  rheumatism,  the  eruptive  fevers,  tubercu- 
lar infiltration,  insolation,  the  development  of  tumors, 
or  syphilitic  growths.  In  all  such  cases  the  earlier 
stages  are  marked  by  a  painful  exaggeration  of  cere- 
bral function  which  renders  sleep  impossible.  The 
wakefulness  of  this  stage  soon  becomes  complicated 
with  delirium;  and  the  whole  is  finally  merged  in  a 
fatal  coma.      Cerebral  excitement  is  the  principal  fea- 

(92) 


ACUTE   AFFECTIONS   OF  THE   BRAIN.  93 

ture  which  arrests  attention.  This  is  accompanied  by 
an  inordinate  determination  of  blood  to  the  head,  pro- 
ducing that  cerebral  hypersemia  which  figures  so 
largely  in  the  works  of  the  humoral  pathologists.  The 
treatment  of  acute  inflammation  becomes  the  best 
means  of  relieving  this  excitement,  allaying  the  hyper- 
aemia,  and  procuring  sleep.  The  treatment  should  be 
derivative,  counter-irritant,  and  calmative.  The  first 
indication  must  be  fulfilled  by  the  exhibition  of  an 
active  purge.  Ten  grains  of  calomel  with  five  grains 
of  sodium  bicarbonate  may  be  given  for  this  purpose. 
Leeches  or  wet  cups  should  be  applied  to  the  temples, 
or  to  the  back  of  the  neck.  The  feet  should  be  placed 
for  a  short  time  in  a  hot  foot-bath,  and  an  ice-cap  must 
be  drawn  over  the  scalp.  The  internal  medication 
must  consist  of  arterial  sedatives  and  cerebral  depress- 
ants. For  the  first,  tincture  of  aconite  forms  an  ad- 
mirable example — ^better  even  than  the  tartar  emetic 
so  much  lauded  by  Graves.  Aconite  may  be  given 
with  the  bromides.  When  sleeplessness  in  an  acute 
meningitis  is  accompanied  by  severe  pain,  an  excellent 
combination  will  be  found  in  the  following: 

^.          Morph.  Sulph.     -  -          -         g^-  i 

Chloral  Hydrat,  -         _         - 

Sodii  Bromid.  aa  -         -           3iv. 

Tr.  Aconit.,  rad.  -         -        gtt.  xxv. 

Tr.   Cardam.  Co.  -         -              3i. 

Aquae,  q.  s.  ad.  -         -         -          ?i. 

Sig. — A  teaspoonf  ul  every  two  hours,  till  relieved. 
As  the  disease  progresses,  the  quantity  of  morphia 
should  be  reduced.    In  epidemic  cerebro-spinal  menin- 


94  INSOMNIA. 

gitis,  opiates  may  be  safely  employed  in  much  larger 
doses  than  are  tolerated  in  the  simple  forms  of  the 
disease.  When  in  doubt  regarding  the  proper  hypnotic 
the  bromides  alone  should  be  used.  Chloral  hydrate 
may  also  be  safely  employed  in  the  first  and  second 
stages  of  meningitis ;  but  if  given  in  full  doses  near 
the  close  of  the  second  stage  it  sometimes  seems  to 
hasten  the  appearance  of  coma.  » 

Insomnia  in  insanity. — Persistent  insomnia  is  often 
one  of  the  premonitory  symptoms  of  insanity.  It  is 
likely  to  present  itself  as  a  most  formidable  complica- 
tion at  any  stage  of  the  disease.  To  consider  aright 
the  relations  that  exist  between  sleeplessness  and  in- 
sanity would  far  exceed  the  limits  of  this  work ;  we  can 
only  review  the  leading  indications  for  its  treatment. 
It  is  occasioned  either  by  an  excited  state  of  the  brain, 
accompanied  by  hypersemia  and  general  functional 
exaltation,  or  by  an  exhausted  and  irritable  condition 
of  the  cerebral  substance.  The  first  of  these  two 
varieties  of  wakefulness  is  encountered  in  cases  of 
violent  maniacal  excitement  where  the  disorder  is  com- 
paratively recent,  and  the  bodily  vigor  has  not  been 
depressed  by  long  continued  disease.  The  indications 
for  treatment  call  for  sedative  measures.  Leeches  be- 
hind the  ears  and  the  application  of  the  ice-cap  are 
sometimes  of  great  service.  Derivative  action  upon 
the  bowels  with  aloetic  purgatives  has  often  yielded 
good  results.  In  like  manner,  hot  mustard  foot  baths 
are  recommended.  The  soothing  effect  of  a  warm  bath 
at  90°  —  95°  F.  is  sometimes  sufficient  to  calm  excite- 
ment, and  to  induce  sleep.  The  combined  effect  of 
cold  applications  to  the  scalp  and  a  warm  bath  to  the 


INSANITY.  95 

general  surface  is  still  more  tranquillizing.  This 
method  of  treatment  is  particularly  useful  in  maniacal 
forms  of  insanity,  and  in  certain  cases  of  melancholia — 
especially  those  in  which  the  skin  is  dry  and  the  secre- 
tions are  disordered. 

Cold  affusions  and  shower  baths  have  been  employed 
for  their  revulsive  and  sedative  effect  in  mania.  This 
mode  of  treatment  is  sometimes  effectual,  but  is  not 
without  risk. 

The  medicinal  treatment  of  insomnia  is  frequently 
facilitated  by  the  measures  above  indicated.  In  cases 
of  great  excitement  with  restlessness  and  bodily  agita- 
tion, it  is  desirable  to  arrest  the  movements  which  are 
wearying  the  patient  and  keeping  him  awake.  This 
may  be  accomplished  by  the  use  of  conium,  as  indicated 
by  Kiernan  [loc.  cit).  Twenty  minims  of  Squibb's 
fluid  extract  may  be  given  for  the  first  dose.  Half 
this  quantity  should  be  repeated  every  half  hour  until 
the  patient  becomes  quite  calm.  Bromide  of  potas- 
sium and  hydrate  of  chloral  in  drachm  doses  should  be 
given  in  connection  with  conium.  Recently,  paraldehyde 
has  been  employed  as  a  substitute  for  chloral.  These 
remedies  reduce  cerebral  excitement,  and  favor  the 
induction  of  sleep  Avhich  is  at  least  refreshing, 
if  not  curative  of  the  disease.  They  should  not,  how- 
ever, be  used  habitually,  for  fear  of  producing  the 
characteristic  consequences  of  over-dosing  with  such 
drugs. 

The  varieties  of  insanity  in  which  depression  and 
exhaustion  are  the  prominent  features  require  different 
management.  Nutritious  food,  alcoholic  restoratives 
and  stimulant  doses  of  opiate  remedies  are  most  ser- 


96  INSOMNIA. 

viceable.  The  sleeplessness  of  melancholia  and  of 
paretic  dementia  may  be  thus  relieved.  Opium  may 
be  given  in  the  form  of  a  pill,  or  in  the  deodorized 
tincture.  The  old  fashioned  "black-drop"  is  highly 
esteemed  by  some.  Others  prefer  the  salts  of  morphia. 
If  cerebral  hypersemia  be  present  in  these  cases,  it  is 
usually  associated  with  asthenic  conditions  of  the 
brain,  indicated  by  paleness  of  the  face  and  weakness 
of  the  pulse.  The  hyperaemic  state  is  then  easily  over- 
come by  the  administration  of  alcohol  or  of  chloral 
with  an  opiate.  If  opiates  alone  are  given  in  cases  of 
insanity  with  great  depression,  there  is  danger  that 
death  by  syncope  may  occur,  precisely  as  it  sometimes 
happens  in  delirium  tremens  when  treated  with  large 
and  frequent  doses  of  opium. 

Cases  are  occasionally  encountered  which  receive 
no  relief  from  opiates.  The  remedy  seems  only  to 
aggravate  the  existing  irritability  and  insomnia.  For 
such  patients  the  tincture  of  hyoscyamus  may  be  em- 
ployed in  doses  ranging  from  two  to  four  or  even  six 
drachms.  Associated  with  bromide  of  potassium  and 
hydrate  of  chloral,  it  has  been  used  with  great  success. 
Spitzka  prefers  the  simple  tincture  rather  than  the 
fashionable  alkaloid,  hyoscyamia. 

Cannabis  indica  associated  with  bromide  of  potas- 
sium is  a  useful  hypnotic  in  cases  of  moderate  depres- 
sion and  excitement.  Clouston  finds  as  a  result  of  his 
experiments  that  "forty-five  grains  of  bromide  of 
potassium  and  forty-five  minims  of  the 'tincture  of  can- 
nabis indica  are  rather  more  than  equivalent  to  a 
drachm  of  laudanum  as  a  means  of  allaying  maniacal 


CHRONIC  ALCOHOLISM.— DELIRIUM  TREMENS.      97 

excitement." '  In  his  recent  work,^  the  same  author 
deprecates  the  use  of  opiates  in  states  of  depression, 
and  advises  the  substitution  of  tincture  of  cannabis 
indica  (x  min. )  and  bromide  of  potassium  (xxgrs.). 
He  also  emphasizes  the  importance  of  abundant  exer- 
cise in  the  open  air,  as  the  best  hypnotic  in  every  case 
that  can  be  trusted  abroad. 

Insomyiia  in  Chronic  Alcoholism  and  Delirium  Tre- 
mens.— The  insomnia  of  chronic  alcoholism  is  depend- 
ent upon  the  extensive  morbid  changes  produced  in 
the  digestive  apparatus  and  in  the  nervous  system  by 
the  habitual  use  of  alcoholic  drinks.  Sleep  becomes 
greatly  disturbed  and  unrefreshing.  It  is  frequently 
broken  by  horrible  dreams.  The  successful  treatment 
of  this  condition  requires  complete  abandonment  of 
the  use  of  alcohol,  and  a  general  correction  of  the  con- 
dition of  the  alimentary  canal.  For  the  immediate 
relief  of  insomnia,  full  doses  of  bromide  of  sodium  will 
be  of  service.  Strong  infusions  of  hops  may  be  given 
ad  libitum.  Cannabis  indica,  in  the  form  of  the  extract, 
so  as  to  avoid  the  use  of  alcohol  in  the  tincture,  is  of 
service.  Hypodermic  injections  of  morphia  are  fre- 
quently employed,  but  should  be  avoided  if  possible, 
for  fear  of  the  opium  habit.  Chloral  hydrate  is  ex- 
ceedingly useful,  but  should  be  given  in  milk,  and  as 
seldom  as  possible,  for  fear  of  adding  to  the  injuries 
already  sustained  by  the  stomach.  For  the  same  rea- 
son the  use  of  paraldehyde  in  such  cases  is  quite 
inadmissable. 

When  chronic  alcoholism  has  culminated  in  delirium 

"^  Psychological  Medicine,  Bucknill  and  Tuke,  4th  ed,,  p.  731. 
^  Clinical  Lectures  on  Mental  Diseases. 
1 


98  INSOMNIA. 

tremens,  more  energetic  measures  become  necessary  in 
order  to  procure  sleep.  If  the  patient  be  of  a  vigor- 
ous constitution,  and  if  the  delirium  be  very  active, 
tartar  emetic  with  morphia  may  be  given,  as  advised 
by  Graves.  Large  doses  of  tincture  of  digitalis,  some- 
times reaching  an  ounce  every  four  hours,  were  used 
by  Jones,  of  Jersey.  Capsicum,  in  scruple  doses  every 
three  hours,  is  said  to  induce  sleep  in  many  cases  of 
delirium,^  especially  in  exhausted  conditions  of  the 
circulatory  organs.  Hydrate  of  chloral  and  bromide 
of  sodium,  each  in  scruple  doses,  may  be  given  every 
two  hours.  Opiates  should  be  used  with  moderation, 
and  all  attempts  to  induce  profound  narcosis  should  be 
avoided.  Drachm  doses  of  tincture  of  cannabis  indica 
and  of  compound  spirit  of  ether,  may  be  given  when  a 
diffusible  stimulant  must  be  associated  with  the  sopo- 
rific. In  desperate  cases  it  is  sometimes  necessary  to 
resort  to  inhalation  of  ether,  but  if  sudden  death  should 
occur,  it  would  be  popularly  ascribed  to  the  effects  of 
the  anaesthetic.  By  reason  of  a  certain  tendency  to 
death  from  syncope  during  this  disease,  it  is  impru- 
dent to  place  such  patients  under  the  influence  of 
chloroform  or  the  other  stronger  anaesthetics. 

Insomnia  in  diseases  of  the  heart  and  blood  vessels. — 
I  can  fully  indorse  the  opinion  of  Ringer  regarding 
the  beneficial  effects  of  morphia  in  the  treatment  of 
the  wakefulness  caused  by  advanced  diseases  of  the  cir- 
culatory organs,  "  In  such  a  case,  the  comfort  afforded 
by  a  hypodermic  injection  is  almost  incredible. 
In  cardiac  dyspnoea,  a  sixth  of  a  grain  twice  or  three 
times  a  week  often  suffices,  but  the  dose  and  frequency 

^Ringer's   Therapeutics.  loth  ed.,  p.  421. 


ANGINA   PECTORIS.  9-^ 

in  severe  cases  must  be  gradually  increased  to  a  quar- 
ter of  a  grain  each  night.  Doctors  are  often  afraid  to 
administer  morphia  in  the  case  of  a  patient  propped 
up  in  bed,  with  livid  ears,  nose  and  nails,  with  dis- 
tended jugulars  and  dropsical  extremities,  with  weak, 
frequent  and  irregular  pulse.  They  dread  lest  the 
morphia  should  weaken  the  heart,  make  the  patient 
worse,  if  not  kill  him  outright.  This  fear  is  quite 
groundless,"  if  the  opiate  be  given  in  moderate  doses. 
It  is  the  stimulant  effect  of  the  medicine  that  is  safe 
and  useful. 

When  wakefulness  is  caused  by  angina  pectoris,  or 
by  simple  cardiac  neuralgia,  such  as  sometimes  follows 
excessive  use  of  tobacco,  relief  may  be  obtained 
through  the  exhibition  of  alcoholic  stimulants,  hydrate 
of  chloral,  or  nitrite  of  amyl.  These  remedies  act 
more  speedily  than  morphia,  and  may  be  associated 
with  it,  to  the  great  advantage  of  the  patient.  They 
should  not  be  habitually  used,  however,  in  cases  of 
cardiac  exhaustion,  as  their  chronic  employment  favors 
accumulation  of  blood  in  the  right  side  of  the  heart, 
with  a  tendency  to  paralysis  of  the  cardiac  muscles.  It 
is  in  stenosis  of  the  coronary  arteries,  and  in  aortic  ob- 
struction, that  nitrite  of  amyl  and  nitro-glycerine  are 
most  useful.  The  insomnia  that  results  from  the 
remote  consequences  of  these  diseases  is  often  relieved 
by  remedies  which  assist  the  circulation  of  blood.  For 
this  purpose  digitalis  is  the  most  useful  stimulant  in 
mitral  disease  ;  nitro  -  glycerine,  in  aortic  valvular 
lesion. 

Insomnia  in  diseases  of  the  respiratory  organs. — 
Pleuritic  pain  and  its  consequent  wakefulness  may  be 


100  INSOMNIA. 

relieved  with  opiates,  guarded  by  appropriate  vascular 
sedatives.     Dover's   powder,  or   morphia   and  aconite, 
form  excellent  examples  of  the  remedies  most  useful, 
so  long  as  the  lungs  are  not  overwhelmed  by  excessive 
exudations  into  the  pleural   cavities.     Pneumonia  and 
bronchitis   are  accompanied  by  wakefulness,   in  their 
earlier   stages,  as  a  consequence  of  harassing   cough. 
This  may  be  allayed  by  the  judicious  use  of  expector- 
ants and  sedatives.     If  symptoms  of  asphyxia  appear, 
indicated  by  blueness  of    the  lips  and  nails,  opiates 
should   never   be   given.     Respiratory  stimulants  are 
then   indicated,  and   sleep  must  be  allured  by  the  use 
of  alcoholic  beverages   and  moderate  doses  of  chloral 
hydrate,  with  musk  and  camphor.      The  early,  irrita- 
tive cough  of  incipient  pulmonary  consumption  may 
be  soothed  with  camphor  and  opium.      Paregoric  and 
a  demulcent,   like  Iceland  moss    tea,  or  flaxseed   tea 
slightly  acidulated  with  lemon-juice,  form  an  excellent 
type  of  such  a  compound.     But  the  chronic  duration 
of  the  disease  renders  the  constant  use  of  opiates  unde- 
sirable.     Chloral  hydrate,  for  the  same  reason,  cannot 
be  given  without  intermission.    It  is  well  in  such  cases 
to  employ  the  different  alcoholic  beverages  at  bedtime. 
Inhalation    of    warm    vapor,    and    respiration   of    air 
charged  with  ether,  or  carbolic   acid,  will   often  quiet 
an  irritative  cough.     In  advanced  cases  belladonna  is 
useful,  to  check  the  profuse  sweating  and  to  calm  the 
thoracic  pain  that  hinders  sleep.     In  the  later  stages 
of  the  disease,  when  relief  from  suffering  is  the  only 
end  in  view,  morphia  and  dilute  hydrocyanic  acid  will 
often  render  quite  tolerable  the  few  remaining  nights 
of  life. 


ASTHMA.— RENAL   DISEASE.  101 

One  of  the  most  distressing  forms  of  insomnia  is 
occasioned  by  the  different  varieties  of  asthma.  Dysp- 
noea is  the  feature  that  is  common  to  them  all,  and  is 
the  principal  exciting  cause  of  wakefulness.  In  recent 
cases,  which  are  characterized  by  spasm,  the  various 
anti-spasmodics  are  useful.  Tincture  of  lobelia,  tartar 
emetic,  and  ipecac,  are  of  great  service.  Inhalations 
of  ether  or  of  chloroform,  or  of  nitrite  of  amyl,  Avill 
often  cut  short  a  paroxysm;  but  the  nervous  system 
soon  becomes  tolerant  of  their  action.  Chloral  hydrate 
and  alcoholic  stimulants  are  less  vigorous,  and  cannot 
be  long  tolerated  by  the  stomach,  especially  if  there  be 
a  gouty  diathesis  behind  the  disease.  The  fumes  of 
burning  pastiles  containing  nitre  and  stramonium 
leaves  are  often  of  great  service  if  so  breathed  as  to 
thoroughly  fill  the  lungs  with  the  smoke.  In  like 
manner,  the  smoke  from  smouldering  nitre-paper,  or 
from  cigarettes  that  have  been  dipped  in  an  arsenical 
solution,  is  sometimes  useful.  Air  charged  with  ozone 
has  been  found  curative  in  some  inveterate  cases. 
Hyoscyamus,  belladonna,  and  tobacco,  have  been  recom- 
mended. It  may  even  become  necessary  to  employ 
hypodermic  injections  of  morphia. 

If,  however,  the  disease  should  resist  all  these  anti- 
spasmodics and  soporifics,  besides  the  remedies  ad- 
dressed to  the  predisposing  causes  of  the  malady,  the 
only  thing  that  remains  is  a  change  of  locality.  Many 
very  desperate  cases  have  thus  been  restored  to  health 
and  comfort. 

Insomnia  in  reJial  disease. — In  the  acute  forms  of 
renal  disorder  this  is  usually  caused  by  pain  and  fever. 
It  is,  therefore,  to  be  relieved  with  opiates  given  in 


102  INSOMNIA. 

connection  with  sucli  arterial  sedatives  and  diaphore- 
tics as  each  individual  case  may  require.  But  the 
tendency  of  inflammatory  diseases  of  the  kidney  to 
merge  in  uraemia  must  not  be  forgotten,  and  the 
soporific  must  be  used  in  such  cases  with  great  cau- 
tion. For  this  reason  hyoscyamus  is  often  preferable 
to  an  opiate.  In  extreme  dropsical  conditions  the 
measures  that  are  useful  for  the  reduction  of  anasarca 
constitute  the  most  ej9&cient  means  for  the  induction  of 
sleep.  In  nephritic  colic  pain  is  too  severe  to  admit 
of  any  rest  while  it  lasts.  The  general  treatment  of 
colic  is  all  that  can  occupy  the  attention  until  relief  is 
secured.  The  dyspnoea  and  wakefulness  sometimes 
experienced  in  advanced  cases  of  Bright' s  disease  may 
be  greatly  relieved  by  the  judicious  use  of  morphia, 
very  much  as  in  the  similar  disorder  occasioned  by 
chronic  diseases  of  the  heart. 

Insomnia  in  diseases  of  the  liver. — Inasmuch  as  the 
majority  of  these  diseases  interfere  with  the  formation 
and  proper  discharge  of  bile  it  is  desirable  to  avoid,  as 
far  as  possible,  the  use  of  opiates  in  the  disturbances 
of  sleep  that  are  so  commonly  consequent  upon 
disorder  of  the  liver.  Simple  restlessness  at  night 
can  usually  be  obviated  by  the  ordinary  treatment  that 
is  remedial  of  the  disease  by  which  it  is  caused.  But 
it  often  happens  that  hypnotic  remedies  must  also  be 
employed.  Hyoscyamus,  belladonna,  chloral  hydrate, 
and  compound  spirit  of  ether,  are  frequently  useful. 
Sometimes  when  the  evacuations  exhibit  a  deficiency 
of  biliary  coloring  matter,  a  grain  of  opium,  with  a 
few  grains  of  calomel,  forms  a  very  efiicient  hypnotic. 
Alcoholic   soporifics   are   not  well   tolerated  when  the 


GASTRO- INTESTINAL  DISEASES.  103 

gastro-intestinal  mucous  membrane  is  diseased.  Biliary 
colic  demands  treatment  similar  to  that  that  is  re- 
quired in  nephritic  attacks.  Warm  baths,  fomenta- 
tions, and  a  broad  belt  of  oiled  silk  around  the  body, 
are  very  grateful,  and  are  favorable  to  the  induction 
of  sleep.  A  course  of  nitro-muriatic  acid,  internally 
and  externally,  is  often  useful  when  wakefulness  is  as- 
sociated with  torpidity  of  the  liver.  ^ 

Insomnia  in  gastro-intestinal  diseases. — In  acute  in- 
flammatory conditions  of  the  stomach  and  bowels,  sleep 
must  be  invited  by  the  use  of  opiates.  Bismuth  and 
morphia,  with  hydrocyanic  acid,  are  the  favorite  means 
of  obtaining  relief.  Opium  in  solid  form  is  sometimes 
preferable  when  a  slowly  developed  and  long  continued 
impression  is  desired.  Warm  baths  and  hot  poultices 
also  give  great  relief. 

In  all  chronic  affections  of  the  alimentary  canal 
opiates  must  be  used  with  great  caution,  for  fear  of  the 
opium  habit,  unless  the  case  be  incurable.  Cancer  of 
the  stomach  requires  their  free  use.  The  milder  dis- 
orders should  be  managed  largely  with  hygienic  treat- 
ment. The  diet  should  be  so  regulated  as  to  prevent 
the  liberation  of  gas  in  the  intestines,  for  their  disten- 
tion in  this  way  is  fatal  to  refreshing  sleep.  A  gentle 
aperient  or  a  large  injection  of  warm  water,  often  proves 
itself  decidedly  soporific  in  such  cases.  Catarrhal  con- 
ditions of  the  mucous  membrane  prohibit  the  entire 
class  of  alcoholic  and  ethereal  soporifics.  Nervous 
and  atonic  dyspepsias  are  often  benefitted  by  the  use 
of  bitter  beer,  and  by  drachm  doses  of  brandy  or 
whisky  largely  diluted.      These   should  be  taken   at 

'  C.  H.  Jones,  Functional  Nervous  Disorders,  p.  284. 


104  INSOMNIA. 

mealtime,  or  with   food  at  bedtime.     A  glass  of  hot 
water  shortly  before  retiring  is  often  useful. 

The  relief  of  insomnia  in  dyspeptic  derangement, 
however,  must  not  be  sought  through  the  administra- 
tion of  anodynes  and  hypnotics  alone.  Only  when  the 
entire  life  of  the  patient  has  been  regulated  upon  a 
physiological  basis  can  refreshing  sleep  be  obtained. 
Change  of  habits,  change  of  occupation,  change  of 
locality — these  are  the  only  curative  measures  in  a 
vast  number  of  the  cases  of  wakefulness  that  occur  in 
modern  life.  Alcohol,  tobacco,  tea,  coffee,  foul  air, 
late  hours,  and  mental  excitement,  are  the  principal 
causes  which  must  be  abolished  before  healthy  sleep 
can  be  enjoyed. 

Insomnia  in  febrile  conditions. — In  the  early  stages 
of  all  acute  fevers  wakefulness  is  a  very  common  inci- 
dent. It  is  then  occasioned  by  irritation  of  the 
brain,  and  must,  therefore,  be  relieved  with  opiates. 
If  the  patient  is  not  depressed  by  the  disease,  the 
opium  should  be  associated  with  tartar  emetic  or 
aconite,  or  ipecac.  Dover's  powder  is  very  useful  in 
such  conditions.  In  malarial  fevers  wakefulness  should 
be  combatted  with  full  doses  of  quinine  in  addition  to 
the  opiate.  Gelsemium  is  sometimes  a  very  satisfac- 
tory remedy — especially  in  the  febrile  attacks  to  which 
children  are  liable.  If  any  evidence  of  cerebral  hyper- 
semia  be  observed,  it  is  well  to  give  chloral  hydrate  and 
the  bromides.  Hyoscyamus,  belladonna,  and  cannabis 
indica  are  useful  when  the  pupils  are  contracted  and 
when  spasmodic  symptoms  are  present.  Lukewarm 
baths,  wet  packs,  and  cool  sponging  are  exceedingly 


FEVERS.— RHEUMATISM   AND   GOUT.  105 

grateful,  and  often  assist  in  the  evolution  of  a  sup- 
pressed eruption  in  the  exanthematous  fevers. 

In  the  later  stages  of  fever  a  condition  of  cerebral 
exhaustion  is  sometimes  encountered.  Irritable  weak- 
ness caused  by  starvation  of  the  brain  is  the  prominent 
feature.  The  pulse  is  small  and  weak.  The  patient 
tosses  and  rolls  from  side  to  side.  He  is  perhaps 
greatly  emaciated  by  an  illness  of  considerable  dura- 
tion. An  elevated  temperature  requires  'frequent 
sponging  of  the  body. 

Opium,  alcohol,  and  liquid  food,  are  the  best  hyp- 
notics in  such  cases.  The  acetum  opii  and  the  deodor- 
ized tincture  of  opium  are  among  the  best  preparations 
of  the  drug,  by  reason  of  their  stimulant  effect.  The 
equivalent  of  two  grains  of  opium  with  a  full  glass  of 
eggnogg,  will  often  procure  sleep  for  such  a  patient. 
li.  there  be  evidence  of  blood  stasis,  with  blueness  of 
the  nails,  hypostatic  pneumonia,  etc.,  musk  and  strych- 
nia should  be  given  in  place  of  opium,  and  the  circu- 
lation should  be  assisted  with  carbonate  of  ammonia, 
as  follows: 

3. 


Ammon.  carb., 

-       gr.  V. 

Spt.  chloroform, 

gtt.   XX. 

Aq.  camphor, 

3  ss. 

To  be  given  in  a  little  milk,  as  required.  Chloral 
and  the  bromides  are  of  comparatively  little  value  in 
all  cases  where  there  is  considerable  depression  of  the 
vital  forces. 

Insomnia  in  rheumcdism  and  gout. —  Opium  in  a 
diaphoretic  preparation,  and  associated  with  alkalies  or 
vdth  colchicum,  has  always  been  the   most   approved 


106  INSOMNIA. 

remedy  for  sleeplessness  in  the  acute  forms  of  these 
painful  diseases.  Salicylic  acid  and  the  salicylates 
have  in  great  measure  superseded  the  use  of  opiates 
for  the  relief  of  pain  and  wakefulness  in  rheumatism, 
but  they  are  not  always  efficient.  Opiates,  with  or 
without  chloral,  must  then  be  used.  Sometimes  a 
painful  case  that  has  resisted  all  other  remedial  agents 
yields  promptly  to  the  action  of  a  series  of  blisters. 
The  chronic  forms  of  rheumatism  require  the  use  of 
stimulant  diaphoretics,  anodyne  liniments  containing 
chloroform  and  belladonna,  and  chloral  hydrate,  or 
even  a  Dover's  powder,  at  night. 

Acute  gout  is  rarely  seen  in  this  country,  but  its 
rudimentary  forms,  described  by  Da  Costa  as  lUhcemia,^ 
are  not  uncommon.  They  are  associated  with  wakeful- 
ness of  a  very  troublesome  character,  which  only  yields 
to  a  persistent  and  long  continued  course  of  treatment 
directed  against  the  diathesis.  Careful  regulation  of 
the  diet,  change  of  air,  and  anti-arthritic  remedies,  are 
of  infinitely  greater  service  than  any  particular  hyp- 
notic drug. 

Insomnia  in  syphilis. — In  advanced  stages  of  syph- 
ilitic cachexia,  a  variety  of  wakefulness  independent  of 
pain  is  sometimes  observed.  It  is  marked  by  a  tendency 
to  wake  at  a  fixed  hour  of  the  night,  frequently  about 
two  o'clock  in  the  morning,  after  which  time  sleep  is 
impossible.  The  symptoms  of  constitutional  disease 
are  not  prominent  in  these  cases,  but  the  history  and 
the  evident  cachexia  make  their  nature  apparent. 
They  usually  yield  to  a  mercurial  treatment.  In 
their  comparative  freedom  from  severe  pain,  such  pa- 

^ Am. /our.  Med.  Sci.,  Oct.,  iSSi,  p.  313. 


SYPHILIS.— DISORDERS   OF  NUTRITION.  107 

tients  present  a  striking  contrast  to  certain  cases  of 
syphilitic  rheumatism,  or  neuralgia.  The  nocturnal 
suffering  in  such  instances  is  frightful.  It  can  be 
finally  overcome  by  anti-syphilitic  treatment;  but, 
while  waiting  for  the  radical  cure,  palliatives  are 
needed.  Chlorodyne  and  similar  combinations  of  all 
the  anodyne  drugs  afford  the  most  effectual  means  of 
relief.  I  have  sometimes  found  it  necessary  to  increase 
the  dose  until  the  characteristic  delirium  produced  by 
solanaceous  drugs  was  manifested.  The  relief  thus 
procured  sometimes  continues  for  many  days  after  the 
cessation  of  hypnotic  medication. 

Insomnia  in  various  disorders  of  nutrition. —  The 
wakefulness  experienced  by  syphilitic  patients  is  not 
peculiar  to  their  cachexia.  It  is  a  result  of  blood  dis- 
order and  impoverishment  that  is  common  among  the 
victims  of  rheumatism,  lithaemia,  syphilis,  malarial 
poisoning,  cancerous  dyscrasia,  chronic  toxaemia  of 
every  form,  and  ordinary  anaemia.  Imperfect  blood 
supply  deteriorates  the  nutrition  of  the  brain,  and  ren- 
ders it  so  excitable  that  sleep  is  interrupted  so  soon  as 
the  period  of  profound  repose  is  past.  This  occupies 
about  four  hours  (see  p.  16),  hence  the  patient  who 
falls  asleep  at  ten  o'clock  is  ready  to  wake  up  at  two  in 
the  morning,  and  only  sleeps  again,  if  at  all,  when 
wearied  with  tossing  till  daylight.  Such  patients  often 
derive  great  benefit  from  a  morning  nap  thus  obtained 
between  the  hours  of  five  and  seven. 

The  most  successful  treatment  of  this  variety  of 
insomnia  is  that  form  of  medication  which  is  addressed 
to  the  particular  cause  of  the  cachexia  or  dyscrasia. 
But  the  palliative  treatment  necessitated  by  the  imme- 


108  INSOMNIA. 

diate  suffering  of  the  patient  will  often  tax  to  the  utter- 
most the  ingenuity  of  the  physician.  Usually,  there  is  . 
a  chronic  atonic  dyspepsia,  or  a  chronic  catarrhal  gas- 
tro-enteritis,  or  a  combination  of  both  conditions,  to  be 
remedied.  Gently  stimulating  laxatives  are  needed 
for  the  relief  of  these  disorders.  An  animal  diet  is 
most  easily  digested.  Milk  and  rare  beefsteaks  supply 
this  form  of  nutriment,  to  which  must  be  added 
oranges,  grapes  and  lemons,  to  prevent  the  develop- 
ment of  incipient  scurvy.  The  kidneys  may  be  ex- 
cited with  small  doses  of  iodide  of  potassium  or  chlo- 
rate of  potassium.  Only  after  a  considerable  course 
of  elimination  are  "  tonics "  admissible.  For  the 
immediate  relief  of  the  insomnia  by  which  the  patient 
is  exhausted,  a  rather  complex  method  is  needful. 
Such  subjects  often  pass  the  day  in  tolerable  comfort, 
but,  as  evening  advances,  the  wearied  brain  becomes 
irritable,  and  bedtime  finds  the  patient  in  an  excited 
state  which  cannot  be  easily  overcome  by  large  and 
repeated  doses  of  chloral.  Paraldehyde  is  too  disa- 
greeable to  be  used  with  impunity,  and  only  towards 
morning  does  the  sufferer  yield  to  the  narcotism 
induced  by  successive  doses  of  chloral  and  bromide.  A 
night  thus  occupied  adds  nothing  to  the  vigor  of  the 
individual,  and  its  frequent  repetition  will  most  surely 
lead  to  starvation  of  the  nerve-centers, —  perhaps  to 
consequent  "  chloral-mania." 

When  the  tendency  to  cerebral  irritation  becomes 
thus  apparent,  great  assistance  can  be  obtained  by  a 
resort  to  the  use  of  opium,  combined  with  tartar  emetic 
and  camphor.  A  pill  containing  one  grain  each  of 
opium  and  camphor,  with  one-twelfth  or  one-sixteenth 


PREGNANCY  AND   PARTURITION.  109 

of  a  grain  of  tartar  emetic,  should  be  given  early  in  the 
evening.  This  calms  the  brain,  and  prepares  the  way 
for  a  moderate  dose  of  chloral  at  bedtime.  In  this 
way  sleep  can  be  procured  with  much  less  expenditure 
of  nervous  force  and  medicine  than  is  wasted  in  the 
ordinary  routine  method.  The  rest  thus  obtained  is 
followed  by  less  depression  than  when  it  follows  stu- 
pefaction with  large  quantities  of  an  exciting  nar- 
cotic. 

Insomnia  during  pregnancy^  and  after  parturition. — 
Closely  akin  to  the  insomnia  of  ansemia  is  the  wakeful- 
ness experienced  by  hysterical  subjects.  The  irritable 
weakness  of  their  brains  renders  them  peculiarly  liable 
to  disturbances  of  sleep.  The  state  of  pregnancy 
often  serves  to  fill  their  nights  with  excitement  suffi- 
cient to  interfere  with  quiet  rest.  Loss  of  blood 
during  parturition,  by  the  induction  of  temporary  anae- 
mia, may  greatly  aggravate  this  condition. 

The  suppression  of  nervous  irritability  is  the  prin- 
cipal indication  for  treatment.  This  may  be  tempora- 
rily accomplished  by  the  use  of  the  bromides.  But  these 
must  be  reinforced  by  an  ample  dietary,  with  stimu- 
lant nervines  and  anti-spasmodics.  Good  wine,  cam- 
phor, valerian,  hyoscyamus,  cannabis  indica,  and 
occasional  doses  of  opium,  will  generally  suffice  to 
induce  the  needful  repose.  If  confinement  in  bed 
precludes  muscular  movement  for  any  length  of  time, 
passive  exercise  must  be  secured  through  the  aid  of 
massage. 

Insomnia  in  spasmodic  diseases.  —  This  class 
of  ailments  will  usually  be  encountered  among  pa- 
tients   who    are     enfeebled     by    unfavorable     condi- 


110  INSOMNIA. 

tions  of  health,  either  congenital  or  acquired.  To- 
gether with  the  specific  treatment  appropriate  to  the 
particular  disorder,  it  often  becomes  necessary  to 
make  use  of  hypnotic  remedies  against  sleeplessness. 
Thus  chorea  may  sometimes  reach  a  degree  of  invet- 
eracy that  renders  sleep  impossible.  Alcohol  and 
chloral  hydrate  must  then  be  given  in  large  and  fre- 
quent doses.  A  laryngeal  catarrh  may  excite  spas- 
modic croup — a  disorder  speedily  relieved  with  chloral 
hydrate.  Old  people  of  a  nervous  temperament  some- 
times experience  paroxysms  of  a  similar  character, 
interfering  with  sleep  whenever  they  suffer  a  catarrhal 
attack.  Liberal  doses  of  assafoetida  and  a  Dover's 
powder  at  night,  associated  with  a  course  of  anti- 
lithic  treatment,  afford  great  relief.  Iodide  of  potas- 
sium, in  the  majority  of  asthmatic  affections;  the  bro- 
mides and  gelsemium  in  cases  marked  by  excitability 
of  the  spinal  cord;  valerian,  musk,  assafoetida,  cam- 
phor, and  carbonate  of  ammonia,  in  cases  of  cerebro- 
spinal weakness  and  irritability ;  oxide  of  zinc,  quinine, 
and  chloral  hydrate,  when  weariness  and  exhaustion 
are  connected  with  a  hypersemic  condition  of  the  brain ; 
such  are  the  principal  remedies  against  this  variety  of 
insomnia.  Convulsions,  if  frequently  repeated,  may 
be  subdued  by  the  inhalation  of  ether  or  chloroform, 
until  a  sufficient  quantity  of  the  bromide  of  potassium 
can  be  introduced  into  the  system. 

Insomnia  in  childhood.  —  According  to  Vierordt,^ 
the  duration  of  sleep  in  the  first  week  of  life  is  only 
interrupted  by  the  act  of  nursing.  During  the  first 
month  the  infant  should  sleep  at  least  two  hours  after 

'  Handbuch  der  JCinderkrankheiten,  Vol.  I.,  p.  214. 


INSOMNIA   IX   CHILDHOOD.  Ill 

each  meal,  waking  only  three  or  four  hours  out  of  the 
twenty-four.  This  period  gradually  increases;  but, 
when  a  year  old,  the  healthy  child  still  sleeps  more 
than  he  wakes.  During  the  second  and  third  years, 
he  should  sleep  for  ten  or  eleven  hours  at  night,  be- 
sides a  nap  of  two  hours  in  the  daytime.  After  the 
fourth  or  fifth  year,  the  daily  nap  may  be  discontinued. 
The  fifth  and  sixth  years  require  ten  hours  of  sleep  at 
night.  From  the  seventh  to  the  eleventh  year,  nine 
hours  are  needed.  After  the  twelfth  year,  eight  hours 
are  sufficient. 

The  causes  of  wakefulness  are  as  numerous  among 
children  as  among  adults.  Jacobi^  insists  upon  the 
importance  of  attention  to  the  ventilation  of  the  bed- 
chamber, and  to  the  quality  of  the  bed.  Everything 
must  be  light,  airy  and  cool.  He  gives  utterance  to 
universal  experience  when  he  asserts  that  great  heat 
can  be  endured  by  day  without  harm,  if  only  the  night 
brings  coolness  and  rest. 

Hunger  is  sometimes  a  cause  of  wakefulness  among 
young  children.  Partial  starvation  endured  for  a 
considerable  time  induces  somnolence.  The  opposite 
condition  of  repletion  may  also  excite  wakefulness 
through  painful  distension  of  the  stomach  and  bowels. 
Earache,  terminating  in  abscess,  often  prevents  sleep, 
sometimes  without  discovery  of  the  cause  until  a  dis- 
charge of  pus  enlightens  the  diagnosis.  Persistent 
wakefulness  without  evident  cause  should  arouse  a  sus- 
picion of  incipient  tubercular  meningitis.  Slight 
elevations  of  temperature  at  night  sometimes  occasion 

^0/.  cit.,  Vol.  I.,  Pt.  2,  p.  153. 


112  INSOMNIA. 

sleeplessness,  which  may  be  overcome  with  quinine  in 
doses  of  two  to  five  grains  at  bedtime. 

Wakefulness  sometimes  occurs  merely  as  the  result 
of  a  bad  habit.  This  is  usually  observed  among  deli- 
cate children  of  a  nervous  temperament,  whose  inclina- 
tions have  never  been  thwarted.  Such  patients  have 
been  sometimes  cured,  after  the  failure  of  a  long  and 
expensive  course  of  treatment  with  homoeopathic 
globules,  by  the  adoption  of  a  systematic  moral  train- 
ing reinforced  by  an  occasional  forcible  application  of 
the  parental  hand  to  the  gluteal  region  of  the  child. 
Of  course  such  a  method  must  not  be  recommended 
without  certain  knowledge  that  no  lurking  disease  of 
the  nervous  system  has  escaped  detection.  Fretful- 
ness  and  wakefulness  are  not  associated  with  proper 
living  and  good  health.  Their  cause  must  generally 
be  sought  upon  the  surface  of  the  body  and  in  its  in- 
ternal cavities. 

Much  relief  in  the  insomnia  of  children  can  be 
obtained  from  the  use  of  lukewarm  baths  at  bedtime. 
Supper  should  be  a  light  but  sufficient  meal.  Every 
disorder  of  digestion  should  be  regulated  as  it  occurs. 
Painful  affections  may  be  quieted  with  Dover's 
powder.  Feverish  and  irritable  conditions  yield  fre- 
quently to  aperients,  or  to  gelsemium  and  quinine. 
Night  terrors  and  screaming  fits  should  be  calmed 
with  chloral  hydrate  and  the  bromide  of  sodium.  As 
a  general  sedative  and  hypnotic  for  children  hyoscya- 
mus  has  an  excellent  reputation.  It  may  be  given  in 
considerable  doses  with  perfect  safety  and  the  best 
results.     For  patients  in  early  life  it  seems  to  fill  the 


OLD  AGE.  113 

place  occupied  by  cannabis  indica  in  the  medication  of 
adults. 

Insomnia  in  old  age. — The  highest  physical  perfec- 
tion is  reached  before  the  fortieth  year  of  life.  Be- 
tween this  age  and  the  forty-fifth  year  man's  vigor 
begins  to  decline.  The  power  of  accommodation 
diminishes,  necessitating  the  use  of  spectacles ;  adipose 
tissues  begin  to  load  the  body;  the  hair  grows  thin, 
and  begins  to  bleach.  The  processes  of  nutrition  and 
of  disassimilation  become  more  sluggish ;  the  appetites 
and  passions  gradually  subside.  Sometimes  the  mod- 
eration of  nervous  excitability  thus  effected  permits 
indulgences  of  the  appetite  for  food  that  were  im- 
possible during  earlier  years — ^the  nervous  dyspeptic 
can  tolerate  dainties  which  would  formerly  have  been 
unendurable.  Less  disturbed  by  the  solicitations  of 
sense,  the  powers  of  reasoning  and  of  judgment 
enlarge  their  authority.  Under  favorable  circum- 
stances this  period  of  life  may  continue  for  about 
twenty  years,  when  old  age  developes.  From  the  six- 
tieth to  the  eightieth  year  the  progress  of  decline  is 
rapidly  accelerated,  and  life  is  normally  terminated 
between  the  eightieth  and  eighty-fifth  years  of  exist- 
ence. The  rare  examples  of  greater  longevity  are  too 
few  in  number  to  warrant  the  assumption  that  a  cen- 
tury of  years  is  the  physiological  complement  of  life. 

As  old  age  advances,  the  time  of  sleep  is  slightly 
abridged.  The  moderated  activity  of  the  body  requires 
only  a  diminished  rate  of  repair  to  make  good  the 
waste  of  the  tissues.  Less  sleep,  therefore,  is  needed. 
But  the  liability  of  age  to  the  incidence  of  arthritic 
diseases,  rheumatism,  and  disorders  of  the  heart, 
8 


114  INSOMNIA. 

blood  vessels,  digestive  apparatus,  and  urinary  organs, 
renders  the  period  of  decline  particularly  subject  to 
those  varieties  of  sleeplessness  which  depend  upon 
such  derangements  of  health.  The  nutrition  of  the 
brain  suffers  under  such  circumstances,  and  the  sub- 
stance of  the  organ  becomes  morbidly  irritable.  In- 
somnia among  the  aged  often  owes  its  cause  to  these 
unwholesome  conditions.  The  biography  of  the  cele- 
brated Carlyle  affords  numerous  illustrations  of  this 
variety  of  wakefulness.  Disease  of  the  cerebral  blood 
vessels  sometimes  originates  a  series  of  changes  differ- 
ing only  in  degree  and  intensity  from  the  classical 
type  of  chronic  periencephalitis.  This  is  character- 
ized by  many  of  the  minor  phenomena  of  general 
paresis,  only  occasionally  rising  to  the  level  of  that 
disease.  Wakefulness  is  one  of  the  most  troublesome 
symptoms  of  this  disorder.  Its  management  requires 
attention  to  all  the  details  of  excretion  and  nutrition. 
The  diet  must  be  carefully  selected  with  reference  to 
failure  of  the  digestive  function.  Milk  and  water 
should  be  preferred  for  drink,  and  the  great  emunctory 
organs  of  the  body  must  be  carefully  stimulated  and 
sustained.  A  judicious  choice  of  climate  may  accom- 
plish much  for  the  comfort  of  the  patient.  The  mild, 
insular  climate  of  Florida,  or  of  New  Providence,  or 
of  the  Sandwich  Islands,  affords  superior  advantages 
for  the  relief  of  sleepless  sufferers  in  the  northern 
temperate  zone  of  the  American  continent,  who  need 
the  soothing  influence  of  a  continual  open  air  bath. 

During  the  latest  stages  of  decline,  when  the  cortex 
of  the  brain  has  become  considerably  atrophied,  the 
opposite  of  wakefulness  is  experienced.     Intellectual 


OLD   AGE.  115 

operations  become  less  vigorous,  and  the  patient  passes 
lengthening  periods  of  time  in  sleep.  This  is  a  genu- 
ine relapse  into  the  apathy  of  infancy.  The  apparatus 
of  thought  is  worn  out,  and  the  old  man  sinks  gradu- 
ally into  the  sleep  from  which  there  is  no  awakening. 
The  treatment  of  insomnia,  therefore,  resolves  itself 
into  the  removal  of  all  special  and  temporary  causes  of 
wakefulness,  with  attention  to  the  general  hygiene  of 
the  patient,  and  careful  regulation  of  his  diet,  habits, 
and  occupation.  Pain  must  be  quelled  with  anodynes. 
Cerebral  excitement  must  be  calmed,  in  sthenic  cases, 
with  anti-spasmodics  and  sedatives — in  asthenic  sub- 
jects it  must  be  overcome  with  food  and  nervous  stimu- 
lants. Since  many  patients  present  a  combination  of 
these  apparently  opposite  conditions,  there  is  room  for 
a  great  display  of  penetration  and  tact  in  the  manage- 
ment of  complex  cases.  While  seeking  for  the  imme- 
diate relief  of  present  suffering,  the  ulterior  conse- 
quences of  treatment  must  always  be  kept  in  view,  and 
the  particular  cachexia  or  dyscrasia  must  be  thoroughly 
appreciated  by  the  physician  in  his  choice  of  remedies. 


CHAPTEK   V. 

DREAMS. 

Behold,  this  dreamer  cometh  ! 

Genesis,  XXXVII,  19. 

The  harmonious  activity  of  all  parts  of  the  nervous 
system  is  indispensable  to  the  highest  exercise  of  the 
conscious  mind.     Healthy  intellectual  life  is  the  per- 
fectly balanced  outcome  of  the  complex    polygon  of 
forces  which  has  its  seat  vrithin  the  brain.     In  the 
waking  condition  this  "moving  equilibrium,"  as  it  has 
been  happily  termed/  is  sustained  by  the  convergent 
impulses    which    are    continually   entering    the    brain 
through  the  pathways  afforded  by  the  several  senses. 
Our  waking  hours  are  occupied  with  the    ideas  and 
with  the  associated  trains  of  thought  which  are  thus 
projected  upon  the  field  of  consciousness.     As  a  con- 
sequence of  the  harmonious  function  of  the  organs  of 
sense,   each  one    supplementing    and    correcting    the 
information  furnished  by  the  others,  a  continuous  pro- 
cess of  perception  and   logical  thought  is  maintained. 
But,    along   with    the    procession  of  ideas  which   are 
clearly  conceived  by  the  mind,  the  field  of   conscious- 
ness is  also  invaded  by  a  cloud  of  half  formed  percep- 
tions, which  are  too  imperfect   and   fleeting  to  occupy 
the   attention.     As   in  the   act  of   vision,   though   the 

'  Herbert  Spencer,  First  Principles,  p.  486. 

(116) 


DREAMS.  117 

periphery  of  the  visual  field  is  crowded  with  a  whole 
world  of  objects  dimly  perceived  without  challenging 
particular  attention,  only  the  center  of  that  field  fur- 
nishing clear  images  to  the  brain,  so  the  eye  of  the 
mind  comprehends  only  a  few  of  the  impressions 
which  enter  the  sphere  of  consciousness.  The  swarm 
of  unnoticed  perceptions,  however,  is  none  the  less  the 
result  of  abiding  sensory  impressions  graven  in  the 
substance  of  the  brain,  from  which,  through  the  action 
of  memory,  they  may  at  any  favorable  moment  reenter 
consciousness.  Sleep  does  not  wholly  arrest  this  pro- 
cess. A  certain  amount  of  projection  into  the  field  of 
consciousness  continues,  even  during  profound  repose; 
and  the  ideas  thus  aroused  form  the  material  of  our 
dreams. 

It  has  already  been  remarked  that  the  invasion  of 
sleep  is  not  an  instantaneous  process.  One  by  one  the 
senses  fall  asleep,  and  long  before  the  final  cessation 
of  their  activity,  sleepiness  hinders  their  function. 
Hence  a  progressive  narrowing  of  the  range  of  exter- 
nal perception;  hence  a  reduction  of  the  vividness  of 
impressions  derived  from  the  outside  world;  hence, 
also,  a  simplification  of  the  actions  and  reactions 
which  constitute  the  "  polygon  of  forces  "  active  within 
the  brain.  But  the  suppression  of  certain  lines  in  this 
polygon  does  not  suppress  life,  nor  does  it  necessarily 
destroy  consciousness.  It  only  occasions  a  redistribu- 
tion of  force,  and  a  proportionate  narrowing  of  the 
stream  of  related  ideas.  Since  this  process  of  sup- 
pression, just  mentioned,  is  not  an  absolute  quantity, 
but  a  variable  factor,  the  polygon  of  physical  forces 
within  the  brain  and  the  corresponding  succession  of 


118  INSOMNIA. 

ideas  in  consciousness  must  necessarily  be  in  a  state  of 
continual  change.  Consequently,  our  dreams  must  be 
as  variable  as  the  clouds  that  drift  upon  the  currents 
of  the  air.  As,  on  a  hot  day  in  summer,  when  the 
equatorial  draught  has  ceased  to  guide  the  wind,  we 
may  observe  all  manner  of  local  tides  among  the 
masses  of  vapor  which  arise  from  the  earth,  so,  in 
sleep,  when  the  guiding  influence  of  the  senses  is  with- 
drawn, the  ideas  that  still  arise  are  chiefly  dependent 
for  their  origin  and  association  upon  the  automatic 
and  endogenous  activities  of  the  brain.  Undisturbed 
by  impulses  from  the  external  world,  the  brain  seems 
then  to  become  more  sensitive  to  impressions  that  have 
their  origin  within  the  body.  An  overloaded  stomach, 
an  enfeebled  heart,  a  turgid  sexual  apparatus,  or  an 
irritable  nervous  ganglion,  may  become  the  source  of 
irregular  and  uncompensated  impulses  which,  without 
disturbing  the  organs  of  special  sense,  may  invade  the 
cerebral  cortex,  and  may  there  set  in  motion  a  whole 
battery  of  mechanisms  whose  influence  upon  conscious- 
ness would  remain  quite  unnoticed  were  the  external 
senses  in  full  operation. 

Still  another  cause  for  the  production  of  dreams  is 
to  be  found  in  the  more  or  less  complete  suspension  of 
the  power  of  volition  which  accompanies  sleep.  Every 
act  of  attention  is  the  result  of  exercise  of  the  will. 
But  the  perfect  exercise  of  the  will  is  dependent  upon 
the  perfect  development  and  wakefulness  of  the  brain. 
So  soon  as  sleep  begins  to  invade  the  brain,  the  will 
begins  to  lose  its  normal  incitement  to  action,  and 
finally  it  becomes  almost  wholly  disconnected  from  the 
muscular  organs.      In  this  state  the  sleeper  may  desire 


DREAMS.  119 

to  perform  some  act  —  he  may  wish  to  move  his  limbs 
or  to  cry  oiit  aloud,  but  he  can  move  neither  hand  nor 
foot,  he  cannot  utter  a  sound.  In  other  instances  a 
partial  connection  between  the  will  and  the  locomotive 
organs  persists,  and  various  orderly  movements  can 
still  be  produced.  In  like  manner  the  control  of  the 
will  over  the  succession  and  association  of  ideas  may 
be  either  wholly,  or  only  partially,  lost  in  sleep.  The 
deeper  the  sleep  the  more  complete  the  loss  of  such 
control;  hence  the  greater  incoherence  as  well  as  fee- 
bleness of  impression  Avhich  is  characteristic  of  dreams 
when  sleep  is  profound.  The  vivid  and  panoramic 
succession  of  visual  conceptions  which  constitutes  a 
"vision,"  occurs  during  light  and  partial  sleep,  when 
the  will  is  still  capable  of  in  some  measure  guiding 
the  procession  of  ideas. 

For  a  similar  reason  the  higher  faculty  of  judg- 
ment, and  especially  the  power  of  arriving  at  moral 
conclusions,  is  in  great  measure  suspended  during 
sleep.  Like  the  power  of  volition,  the  activity  of  the 
moral  sense  is  dependent  upon  a  certain  functional 
perfection  in  the  brain.  When  the  capacity  of  the 
brain  is  depressed  by  drugs  or  by  disease,  or  by  sleep, 
the  moral  sensibilities  are  the  first  to  disappear.  Hence 
the  non-moral  character  of  the  impressions  usually 
experienced  during  the  act  of  dreaming.  We  feel 
neither  surprise  nor  regret  at  the  incidents  of  ordinary 
dreams.  It  is  only  when  the  border  line  of  wakeful- 
ness is  reached  that  the  dreamer  feels  ashamed  of 
walking  naked  in  his  dream,  or  feels  compunction  for 
an  act  of  crime,  or  experiences  emotions  of  joy  or  sor- 
row in  connection  with  the  incidents  of  his  vision. 


120  INSOMNIA.. 

A  dream  may,  therefore,  be  defined  as  the  occupa- 
tion of  the  field  of  consciousness  during  sleep  by  a 
succession  of  ideas  more  or  less  completely  withdrawn 
from  the  guidance  of  the  senses  and  from  the  control 
of  the  will.  A  great  variety  of  dreams  may  thus  be 
admitted,  ranging  all  the  way  from  those  products  of 
mere  absence  of  mind  which  constitute  revery,  down  to 
the  faintest  and  feeblest  stirrings  of  consciousness 
which  have  been  always  observed  during  the  act  of 
waking  from  the  profoundest  sleep. 

Considerable  light  may  be  thrown  upon  the  produc- 
tion of  dreams  if  we  consider  attentively  the  manner  in 
which  illusions  and  hallucinations  are  excited  by  the 
use  of  drugs  or  by  disease  during  the  waking  state. 
When  engaged  in  experimenting  upon  myself  with 
different  medicines,  I  once  took  a  dose  of  hasheesh 
sufficient  to  produce  the  peculiar  effects  of  the  drug. 
Sitting  quietly  in  my  chair,  the  first  unusual  sensation 
was  an  agreeable  feeling  of  coolness  diffusing  itself 
over  the  surface  of  the  body,  as  if  some  one  were 
gently  fanning  me  on  a  hot  day.  A  feeling  of  cause- 
less amusement  began  to  occupy  my  mind.  I  seemed 
to  be  smiling  all  over  without  any  apparent  reason  for 
hilarity.  Then  the  walls  of  the  room  in  which  I  sat 
seemed  to  recede  to  a  vast  distance.  My  attention  be- 
came riveted  upon  a  little  picture  which  hung  against 
the  wall  before  me.  It  was  a  sunset  scene,  painted 
upon  a  canvas  scarcely  larger  than  my  hand.  As  the 
wall  upon  which  it  was  placed  seemed  to  recede,  the 
canvas  expanded  until  I  beheld  a  glorious  landscape 
bounded  by  a  range  of  snow-capped  mountains  flushed 
with  purple  light  from  the  setting  sun.      As  I  sat,  ad- 


DREAMS.  121 

miring  this  splendid  scene,  the  gilded  frame  of  the 
painting  became  alive  with  winged  fairies  and  cherubs, 
peeping  out  from  behind  the  moulding,  and  bending 
over  its  margin  to  look  into  the  picture.  Then  the 
ceiling  of  the  room  and  the  sky  of  the  picture  seemed 
to  blend  in  one  common  expanse  of  ethereal  blue ;  the 
sunlight  faded  from  the  mountain  peaks ;  stars  began 
to  appear  in  the  firmament ;  the  little  imps  and  fairies 
disappeared;  and,  presently,  everything  resumed  its 
natural  appearance. 

In  this  experience  the  departure  from  healthy  cere- 
bral function  consisted  in  an  exaltation  of  certain  forms 
of  sensibility  while  others  were  depressed.  The  suc- 
cession of  visual  images  was  initiated  by  the  visible 
objects  around  me,  but  it  was  enriched  by  the  associa- 
tion of  ideas  furnished  through  the  stimulation  of 
memory.  The  sunset  glow,  the  snow-capped  moun- 
tains, the  starry  sky,  were  familiar  objects,  suggested 
from  memory  by  the  items  grouped  in  the  picture.  In 
like  manner,  the  cherubs  who  climbed  upon  its  gilded 
frame  were  merely  the  glorified  products  of  memory, 
probably  suggested  by  the  fact  that  it  was  a  picture 
upon  which  my  attention  was  fixed — one  picture  re- 
minding me  of  others  which  I  had  seen.  The  loss  of 
proportion  in  the  view — the  exaggeration  and  distortion 
of  all  the  relations  of  time  and  space,  which  made  the 
unreal  seem  real,  and  conferred  grandeur  upon  com- 
monplace objects,  was  undoubtedly  occasioned  by  a 
modification  in  the  molecular  structure  of  the  organs 
of  special  sense  and  of  perception  under  the  influence 
of  hasheesh.  The  change  thus  effected  was  of  a 
character  to  diminish  the  force  of  sensory  impressions 


122  INSOMNIA. 

derived  through  the  aid  of  the  muscles  and  nerves  of 
the  eye  and  the  ear  and  the  skin,  while  at  the  same 
time  exaggerating  the  processes  of  memory  and  asso- 
ciation in  connection  with  impressions  originating 
within  the  brain.  In  this  way  was  produced  a  sort  of 
confusion  between  the  external  world  and  the  ideal 
world  within,  rendering  it  difficult  to  distinguish  the 
one  from  the  other.  Hence  the  impossibility  of  esti- 
mating aright  the  relation  of  time  and  space  to  the 
visual  impressions  upon  which  attention  was  fixed. 
The  result  was  a  waking  dream  which  differed  from 
ordinary  revery  chiefly  in  the  intensity  of  the  impres- 
sions that  occupied  the  mind. 

A  somewhat  similar  process  is  sometimes  experi- 
enced as  a  consequence  of  cerebral  disorder  uncon- 
nected with  the  effects  of  drugs.  During  the  invasion 
of  measles,  having  taken  no  medicine  but  sage  tea,  I 
remember,  as  night  approached,  a  strange  succession 
of  illusions.  My  head  seemed  to  expand  to  the  size  of 
a  bushel  basket;  then  it  would  slowly  contract  again. 
My  body  seemed  to  grow  out  of  shape  into  the  most 
distorted  forms  of  rickets.  Audible  sounds  seemed  to 
come  from  the  most  remote  distances.  Impending 
shadows  of  a  great  darkness  hovered  over  the  bed. 
Waves  of  heat,  and  tingling  darts  of  numbness 
traversed  my  limbs.  These  singular  and  rather  un- 
comfortable sensations  continued  until  relieved  by  an 
ordinary  Dover's  powder. 

In  this  experience  the  confusion  of  ideas,  though 
less  agreeable,  was  essentially  similar  to  that  occa- 
sioned by  the  action  of  the  hasheesh.  In  both  cases 
there  was  the  same  diminution  of  the  intensity  of  ex- 


DREAMS.  123 

ternal  sensation  accompanied  by  an  exaggeration  of 
internal  impressions.  The  brain  and  the  nerves  were 
in  a  condition  of  irritable  weakness,  caused  by  disease, 
which  interfered  with  the  normal  generation  and  asso- 
ciation of  ideas.  Having  thus  partially  escaped  from 
the  control  of  the  senses  and  the  will,  the  mutilated 
succession  of  ideas  which  reached  the  field  of  con- 
sciousness could  only  be  perceived  as  a  series  of  illu- 
sions. Here,  again,  was  a  waking  dream,  of  origin 
and  course  analogous  to  the  illusions  and  hallucina- 
tions which  accompany  every  form  of  delirium. 

It  is  not  alone  under  the  influence  of  disease  or  of 
drugs  that  the  automatic  action  of  the  brain  furnishes 
ideas  for  the  inspection  of  the  mind.  Riding,  one  day, 
in  a  street-car,  and  reading  a  philosophical  work,  I 
came  upon  a  paragraph  devoted  to  a  discussion  of  the 
doctrine  of  the  association  of  ideas.  Immediately,  out 
of  memory,  flashed  a  momentary  vision  of  the  quarter 
deck  of  the  old  frigate,  United  States,  upon  which 
appeared  the  figure  of  a  very  small  midshipman,  talk- 
ing to  a  gigantic  personage,  the  captain  of  the  ship. 
This  was  an  incident  which  I  had  actually  witnessed 
forty  years  before.  I  was,  at  first,  somewhat  puzzled 
in  the  attempt  to  account  for  the  occurrence  of  a  vision 
so  apparently  incongruous  with  the  subject  matter  of 
the  book;  but  a  little  reflection  convinced  me  that  the 
exciting  cause  of  this  seemingly  involuntary  act  of 
memory  was  really  the  idea  of  association  suggested 
by  the  book.  This  had  unconsciously  aroused  the  ap- 
paratus of  association  in  the  brain,  and  the  particular 
scene  thus  brought  before  the  mind  had  been  further 
suggested  by  the   circumstance  that  the   last  object, 


124  INSOMNIA. 

external  to  the  printed  page,  upon  which  I  had  fixed 
my  attention,  was  a  large  ship,  lying  in  the  river,  near 
the  bridge,  just  crossed  by  the  car  in  which  I  rode. 

Numerous  other  examples  of  a  similar  character 
might  be  related  to  illustrate  the  fact  that  the  brain 
is  a  reservoir  of  sensory  impressions,  some  of  which, 
at  the  moment  of  their  original  incidence,  have  aroused 
the  mind  to  a  greater  or  less  degree  of  conscious  atten- 
tion, and  have  then  all  lapsed  into  a  latent  or  potential 
condition.  But,  though  latent,  they  are  none  the  less 
persistent,  and  only  await  the  suppression  of  other 
inhibitory  forces  to  become  once  more  capable  of  arous- 
ing attention.  Such  inhibitory  impulses  are  continu- 
ally furnished  by  the  action  of  the  sensory  organs  on  the 
one  hand,  and  by  the  energy  of  the  mind  upon  the  other. 
So  soon,  therefore,  as  the  organs  of  sense  and  of  volun- 
tary impulse  are  sealed  with  sleep,  if  the  remaining 
portions  of  the  brain  are  still  operative,  and  are  left  to 
their  own  unrestrained  activity,  a  more  or  less  disorderly 
series  of  ideas  occupies  the  mind.  This  constitutes  a 
dream.  The  difference,  therefore,  between  waking 
thought  and  a  di'eam  is  analogous  to  the  difference 
between  a  page  upon  which  the  words  have  been 
arranged  in  a  rational  order,  and  another  page  upon 
which  some  of  the  same  words  have  been  set  down  at 
random.  Inasmuch  as  the  majority  of  our  sensations 
are  derived  through  the  organs  of  sight,  and  since  the 
larger  portion  of  the  sensory  region  of  the  cortex  of 
the  brain  is  concerned  in  the  act  of  vision,  it  is  no 
more  than  might  be  expected  that  the  ideas  suggested 
in  sleep  should  generally  proceed  from  the  visual  ap- 
paratus of  the  brain.     The  superior  power  of  visual 


DREAMS.  125 

impressions  to  attract  attention  may  also  serve  to  ex- 
plain the  fact  that  the  majority  of  dreams  are  composed 
of  images  that  were  originally  perceived  in  the  act  of 
vision.  Hence  our  dreams,  for  the  most  part,  consti- 
tute a  series  of  pictures  undisturbed  by  sound,  or  by 
other  forms  of  sensation.  But  this  is  not  always  so. 
It  is  highly  probable  that  when  the  organs  of  external 
sense  are  allowed  to  sleep  without  disturbance,  our 
dreams  consist  of  visual  impressions  alone.  But,  if 
any  unusual  sound,  or  smell,  or  other  sensation  is 
experienced  during  sleep,  it  may  penetrate  the  field  of 
consciousness,  and  may  become  the  starting  point  of  a 
dream  quite  filled  with  sounds.  Thus  a  young  lady, 
who  had  passed  the  evening  at  a  musical  concert,  was 
aroused,  soon  after  retiring,  by  the  striking  of  a  clock 
which  had  been  recently  placed  in  her  chamber.  At 
the  moment  of  waking,  she  was  dreaming  of  an  orches- 
tral performance  of  Wagner's  music.  Doubtless  the 
dream  was  suggested  by  the  unaccustomed  sound  of 
the  clock. 

The  possibility  of  thus  suggesting,  and  in  some 
degree  guiding,  the  form  and  course  of  a  dream,  has 
been  often  demonstrated.^  One  of  my  early  school- 
mates, a  boy  of  remarkably  susceptible  nervous  tem- 
perament, furnished  an  excellent  example  of  this  spe- 
cies of  direction.  Tickling  his  nose  with  a  straw  made 
him  dream  that  a  dragon-fly  was  assaulting  his  face. 
On  another  occasion,  a  few  drops  of  vinegar  placed 
upon  his  tongue  caused  him  to  dream  of  eating  oranges. 
Again,  one  of  his  companions  roguishly  breathing  in 
his  ear  the  statement  that  the  schoolmaster  was  after 

'A.  Maury.     Le  Sotmneil et  les  Rives, p.  154, 


126  INSOMNIA. 

him  with  a  long  rattan,  he  bounded  out  of  bed,  and 
could  scarcely  be  restrained  from  bursting  out  of  doors 
in  his  evident  alarm.  I  was  myself  awakened,  one 
night,  by  the  ringing,  as  it  seemed,  of  my  doorbell ; 
but,  hastening  at  once  to  the  door,  no  one  was  there. 
As  I  was  expecting  a  call  from  a  certain  patient,  I  con- 
cluded that  the  bell  had  been  rung  by  an  impatient 
messenger  who  could  not  wait.  Falling  again  asleep, 
I  was  a  second  time  startled  by  a  similar  ring.  Look- 
ing out  of  the  window  above  the  door,  it  was  evident 
that  no  one  was  there.  I  finally  concluded  that  the 
sound  must  have  been  perceived  in  a  dream,  and  I 
recalled  the  fact  that  each  time,  as  I  woke,  the  sound 
of  a  carriage,  passing  the  house,  had  attracted  my 
attention.  Undoubtedly,  the  state  of  expectancy  in 
which  I  was  sleeping  had  operated  as  the  predisposing 
cause  of  dreaming,  and  the  noise  of  wheels  upon  the 
pavement  had  served  as  the  exciting  cause  of  a  dream 
in  which  the  sound-vibrations  communicated  to  the 
brain  had  produced  by  an  association  of  ideas  the  par- 
ticular perception  which,  though  asleep,  I  was  waiting 
to  receive. 

In  certain  cases  the  impression  produced  by  a  dream 
is  so  vivid  that  a  considerable  time  after  waking  must 
elapse  before  it  can  be  relegated  to  its  true  position  in 
the  world  of  hallucinations.  Dreaming,  once,  that  my 
wife  called  to  me  from  another  room,  I  instantly  awoke ; 
and  only  the  fact  that  she  was  with  me  could  satisfy 
me  that  it  was  all  a  dream.  Taine  '  relates  that  "  M. 
Baillarger  dreamed  one  night  that  a  certain  person  had 
been  appointed  editor  of  a  newspaper;  in  the  morning 

'  On  Intelligence ,  p.  6i. 


DREAMS.  127 

he  believed  it  to  be  true,  and  mentioned  it  to  several 
persons  who  were  interested  to  hear  it; — the  effect  of 
the  dream  persisted  all  the  forenoon,  as  strongly  as 
that  of  a  real  sensation;  at  last,  about  three  o'clock,  as 
he  was  stepping  into  his  carriage,  the  illusion  passed 
off;  he  comprehended  that  he  had  been  dreaming." 

The  following  incident  from  the  experience  of  Prof. 
Jessen,  physician  to  the  insane  asylum  in  Homheim, 
near  Kiel,^  still  further  illustrates  this  form  of  halluci- 
nation : 

"On  a  wintry  morning,"  writes  the  professor,  "be- 
tween five  and  six  o'clock,  I  was  aroused,  as  I  thought, 
by  the  head  nurse,  who  reported  to  me  that  some  peo- 
ple had  come  for  one  of  the  male  patients,  and  who  at 
the  same  time  asked  me  whether  I  had  any  particular 
orders  to  give.  I  replied  that  the  patient  might  de- 
part, and  after  he  had  left  the  room  I  turned  around 
to  go  to  sleep  again.  All  at  once  it  struck  me  that  I 
had  previously  not  heard  anything  regarding  the  in- 
tended departure  of  this  patient,  but  that  only  the 
prospective  departure  of  a  woman  of  the  same  name 
had  been  reported  to  me.  This  compelled  me  to  in- 
quire more  particularly  after  the  circumstances,  and 
accordingly  I  lighted  a  candle,  rose,  dressed  myself, 
and  went  to  the  room  of  the  head  nurse.  To  my  sui*- 
prise  I  found  him  only  half  dressed,  and,  in  reply  to 
my  inquiry  after  the  people  who  had  called  for  the 
patient,  he  said,  with  an  expression  of  astonishment, 
that  he  did  not  know  anything  of  it,  as  he  had  but  just 
left  his  bed,  and  no  one  had  called  him.  This  answer  did 

'Wharton  and  Stille's  Medical  Jurisprudence,  Third  Edition,  Vol. 
I,  p.  482. 


128  INSOMNIA.. 

not  arouse  my  consciousness,  but  I  rejoined  that  then 
the  steward  must  have  been  in  my  room,  and  that  I 
should  accordingly  go  to  see  and  ask  him  regarding 
the  matter.  When  descending  a  few  steps  in  the  mid- 
dle of  the  corridor  which  led  to  the  room  of  the  stew- 
ard, I  suddenly  became  conscious  of  having  dreamed 
only  what  until  that  moment  I  had  believed  to  be  an 
experience  whose  reality  I  had  not  doubted  in  the 
least." 

In  some  instances  the  fact  of  having  dreamed  is 
never  recognized,  and  the  dreamer  carries  through  life 
the  delusion  that  his  vision  was  an  actual  occurrence. 
Among  the  Indians  of  Guiana,  and  the  same  thing  is 
true  of  many  other  savages,  dreams  are  looked  upon  as 
actual  events  in  which  the  dreamer  is  visited  by  spirits 
or  even  by  other  living  men.  A  recent  English 
traveler'  says:  "It  becomes  important,  therefore, 
fully  to  recognize  the  complete  belief  of  the  Indian  in 
the  reality  of  his  dream-life,  and  in  the  unbroken  con- 
tinuity of  this  with  his  working  life.  It  is  easy  to 
show  this  belief  by  many  incidents  which  came  under 
my  notice.  For  instance,  one  morning,  when  it  was 
important  to  me  to  get  away  from  a  camp  on  the 
Essequibo  River,  at  which  I  had  been  detained  for 
some  days  by  the  illness  of  some  of  my  Indian  com- 
panions, I  found  that  one  of  the  invalids,  a  young 
Macusi,  though  better  in  health,  was  so  enraged  against 
me  that  he  refused  to  stir,  for  he  declared  that,  with 
great  want  of  consideration  for  his  weak  health,  I  had 
taken  him  out  during  the  night  and  had  made  him  haul 

^  Amoji^i^  the  Indians  of  Guiana.  By  Everard  F.  Im  Thurn.  Lon- 
don:  1883,  p.  344. 


DREAMS.  129 

the  canoe  up  a  series  of  difficult  cataracts.  Nothing 
could  persuade  him  that  this  was  but  a  dream,  and  it 
was  some  time  before  he  was  so  far  pacified  as  to  throw 
himself  sulkily  into  the  bottom  of  the  canoe.  At  that 
time  we  were  all  suffering  from  a  great  scarcity  of 
food,  and  hunger  having  its  usual  effect  in  producing 
vivid  dreams,  similar  effects  frequently  occurred.  More 
than  once  the  men  declared  in  the  morning  that  some 
absent  men,  whom  they  named,  had  come  during  the 
night  and  had  beaten  or  otherwise  maltreated  them; 
and  they  insisted  upon  much  rubbing  of  the  bruised 
parts  of  their  bodies." 

It  is  highly  probable  that  from  these  facts,  and 
from  others  of  a  similar  character,  may  be  derived  the 
true  explanation  of  many  of  the  supposed  examples  of 
intercourse  with  divine  or  angelic  persons  which  oc- 
cupy so  important  a  place  in  early  mythology.  An 
incident  in  the  childhood  of  the  prophet  Samuel  can 
scarcely  admit  of  any  other  interpretation.  In  other 
cases,  notwithstanding  the  intensity  of  the  dream,  its 
true  character  is  recognized  by  the  dreamer  during  the 
very  act  of  vision.  Thus,  I  once  dreamed  that  I  saw  a 
young  girl  standing  before  me.  So  vivid  was  the  per- 
ception, that  the  actual  presence  of  such  a  person  could 
not  have  produced  a  more  perfect  impression  upon  the 
waking  brain.  Yet,  at  the  same  instant,  I  compre- 
hended the  fact  that  it  was  merely  a  dream,  and  re- 
marked the  difference  between  the  intensity  of  the 
visual  image  in  this  and  in  other  dreams.  Such  speedy 
recognition  of  the  hallucination  does  not  always  accom- 
pany the  act  of  waking  out  of  a  dream.  In  some 
cases,  as  we  shall  have  occasion  to  see,  the  images 
9 


130  INSOMNIA. 

which  have  figured  in  a  dream  are  still  perceived  for  a 
certain  period  of  time  after  awaking. 

The  majority  of  dreams  are  composed  of  visual 
images.  The  dreamer  looks  upon  a  picture  which 
changes  silently  before  his  eyes,  without  appealing  to 
any  other  sense  than  that  of  sight.  But  in  certain 
cases  any  other  sense  may  become  excited,  producing 
illusions  or  hallucinations  as  perfect  as  the  images  of 
healthy  vision.  They  may  be  suggested  by  external 
impressions,  as  in  my  dream  of  a  ring  at  the  door  bell, 
which  proved  to  be  an  auditory  illusion  excited  by  the 
sound  of  passing  carriage  wheels ;  or  they  may,  at  least 
apparently,  find  their  starting  point  in  accidental  states 
of  the  bodily  organization.  If  attention  be  paid  to  this 
matter,  it  will  be  observed  that  all  unusual  modes  of 
dreaming,  and  all  extraordinary  vividness  of  dream- 
impressions  can  be  connected  with  some  departure 
from  the  physiological  conditions  of  quiet  sleep. 
Either  disease,  or  exhaustion,  or  emotional  disturb- 
ance, or  narcotic  intoxication  of  the  brain  may  be 
noted  as  the  immediate  cause  of  such  derangement  of 
the  cerebral  functions.  After  drinking  several  cups  of 
coffee  before  retiring,  I  dreamed  of  a  large  yellow 
flower  which  exhaled  a  very  fragrant  odor.  During 
the  same  night  I  also  di'eamed  of  drinking  wine,  which 
agreeably  excited  the  senses  of  taste  and  of  smell. 
Upon  another  occasion,  having  been  disturbed  by  the 
entrance  of  burglars  into  my  house,  I  dreamed  that  a 
burglar  was  fumbling  under  my  pillow,  and  was  raising 
my  head  and  shoulders  with  the  mattrass  upon  which 
I  slept.  I  seemed  to  feel  the  changes  of  pressure  and 
of  contact  as  distinctly  as  if  awake.      The  connection 


DREAMS.  131 

of   voluptuous    illusions    with    erotic    dreams  is   too 
familiar  to  require  particular  mention. 

Dreams  are  not  always  limited  to  the  revival  and 
combination  of  the  images  of  sensation.  Intellectual 
combinations  are  sometimes  thus  presented  to  the 
mind.  The  most  familiar  illustrations  of  this  fact  are " 
furnished  by  the  experience  of  mathematicians  who 
have  worked  out  mathematical  problems  in  their 
dreams.  One  of  my  patients,  an  expert  book-keeper, 
dreamed  of  adding  up  six  columns  of  figures  at  once. 
In  the  morning  he  still  remembered  his  dream;  and, 
on  adding  up  the  columns,  found  that  he  had  actually 
produced  the  right  sum  in  each  case.  A  college 
student  of  my  acquaintance,  who  was  puzzled  by  a 
geometrical  proposition,  wrote  out  the  correct  solution 
during  his  sleep.  This  was  something  more  than 
simple  dreaming ;  it  trenched  upon  actual  somnambu- 
lism. Another  acquaintance  dreamed  of  being  in 
heaven,  and,  while  there,  experienced  relief  from  doubt 
regarding  certain  theological  doctrines  which  had  pre- 
viously exercised  his  mind.  I  have  myself  composed 
several  sentences  during  the  course  of  a  dream,  and 
have,  while  dreaming,  sometimes  esteemed  them  worthy 
of  preservation ;  but  my  waking  recollection  has  never 
coincided  in  this  particular  with  the  opinions  formed 
during  sleep. 

Great  difference  between  dreams  may  be  remarked 
in  their  coherence  and  continuity  of  evolution.  Some 
are  composed  of  the  most  inconsistent  elements  without 
order  or  logical  arrangement.  In  others  the  incidents 
follow  very  closely  in  the  line  of  a  natural  and  rational 
development,  so  that  the  dreamer  seems  to  be  present 


132  INSOMNIA. 

as  a  spectator  of  a  perfectly  coherent  drama.  It  is 
probable  that  these  differences  depend  upon  variations 
in  the  degree  of  completeness  with  which  the  different 
parts  of  the  brain  and  of  the  body  are  overwhelmed  by 
sleep.  If  different  and  widely  separated  portions  are 
sufficiently  wakeful  to  suggest  ideas  to  the  mind,  the 
resulting  congeries  will  consist  of  discordant  and  in- 
coherent elements.  But  if  wakefulness  is  limited  to  a 
particular  organ  of  the  body  or  to  a  circumscribed  ter- 
ritory of  the  brain,  the  resulting  impressions  in  con- 
sciousness should  be  correspondingly  restricted,  and 
will  manifest  a  more  orderly  connection  with  each 
other.  In  some  cases  a  tendency  to  simultaneous 
wakefulness  of  particular  portions  of  the  cerebral 
register  seems  to  become  habitual,  so  that  the  same  set 
of  ideas  may  be  often  renewed  in  the  same  order  dur- 
ing sleep,  constituting  a  repetition  of  the  same  dream. 
In  this  way  I  have  frequently  dreamed  of  a  volcanic 
eruption  of  molten  lava  from  a  lofty  mountain.  This 
frequent  revival  of  the  same  train  of  images  is  prob- 
ably due  to  the  fact  that  in  childhood  I  actually  wit- 
nessed a  volcanic  outbreak,  and  that  a  very  highly 
colored  picture  of  Vesuvius  in  eruption  hangs  in  my 
sitting  room,  so  that  my  brain  has  become  profoundly 
impressed  with  this  particular  image.  When  other 
portions  of  the  brain  are  asleep,  if  the  special  region 
concerned  with  this  picture  be  aroused,  the  mind  re- 
ceives the  same  impression  which  it  received  when  first 
excited  by  that  portion  of  the  organ  of  memory. 

As  a  general  thing,  however,  dreams  do  not  possess 
any  such  compactness  and  coherence.  They  are 
usually  derived  from  many   different  portions  of   the 


DREAMS.  133 

cerebral  organ,  even  when  they  seem  to  exhibit  a 
fluently  connected  course.  Thus,  I  di*eamed,  one 
night,  that  I  was  walking  in  a  garden  filled  with  pecu- 
liar oriental  shrubbery.  In  this  garden  I  discovered 
one  of  my  brothers  and  a  friend,  who  is  widely  known 
in  literary  circles,  engaged  in  flying  a  kite.  With 
great  adroitness  they  had  succeeded  in  causing  the 
kite-string  to  describe  in  the  air  the  outline  of  the  let- 
ter Z.  I  congratulated  them  on  the  adoption  of  so 
truly  scientific  a  method  of  kite-flying;  telling  them, 
also,  that  I  had  once  succeeded  in  making  a  kite-string 

describe  a  fourth  line,  thus  :  N-     As  they  expressed 

surprise  at  this,  I  told  them  that  in  the  May  number 
of  the  Atlantic  Monthly,  for  1883,  they  would  find  an 
article  on  this  method  of  kite-flying,  written  by  Oliver 
Wendell  Holmes. 

Nothing  can  seem  more  absurd  than  such  a  sequence 
of  ideas.  They  follow  each  other  without  a  break,  yet 
without  any  logical  coherence,  very  like  the  order  in 
which  ideas  arise  to  occupy  the  mind  of  an  insane  per- 
son. Indeed,  such  dreams  suggest  the  doctrine  that 
the  condition  of  a  dreamer's  brain  is  functionally  iden- 
tical with  what  obtains  in  certain  forms  of  insanity. 
At  first  sight  it  would  seem  as  if  such  a  dream  could 
have  no  possible  basis  in  fact.  But  a  brief  retrospec- 
tion enabled  me  to  trace  each  individual  item  to  its 
source  in  memory,  and  I  was  able  to  construct  the  fol- 
lowing key  to  the  vision:  During  the  previous  even- 
ing I  had  been  examining  a  number  of  East  Indian 
photographs.  Among  the  most  remarkable  of  them 
was  a  picture  of  the  glorious  gardens  of  the  Taj,  at 
Agra.      Another    represented    the    ruined    Buddhist 


134:  INSOMNIA. 

tower  at  Sarnath,  a  structure  remarkable  for  the  nu- 
merous triangular  figures  carved  as  ornaments  upon  its 
sides.  Hence  the  garden  and  the  zigzag  kite-string  in 
the  dream.  During  the  day  before,  while  conversing 
with  a  neighbor  regarding  the  financial  misfortunes  of 
an  acquaintance,  I  had  remarked  that  if  he  had  stopped 
kite-flying,  and  had  settled  down  to  legitimate  busi- 
ness at  last,  he  would  doubtless  do  well  in  the  future. 
Hence  the  kite.  I  had  recently  received  an  interest- 
ing letter  from  my  literary  friend  in  which  he  had 
mentioned  my  brother.  Hence  the  two  principal, 
actors  of  the  dream.  Just  before  retiring,  that  night, 
I  had  discussed  with  my  wife  the  subject  of  subscrib- 
ing for  a  number  of  periodical  magazines.  Hence  the 
Atlantic  Monthly;  and,  as  the  celebrated  Oliver  Wen- 
dell Holmes  was  the  author  most  intimately  associated 
in  my  mind  with  that  periodical,  his  introduction 
among  the  characters  of  the  dream  followed  most 
naturally  in  accordance  with  the  law  of  the  association 
of  ideas. 

The  question  is  continually  asked,  why  are  certain 
dreams  so  vivid  and  so  easily  remembered,  while  others 
are  of  the  faintest  and  most  evanescent  character?  My 
own  experience  leads  me  to  believe  that  there  is  a  mor- 
bid element  underlying  all  unusually  vivid  dreams.  It 
is  not  merely  because  of  differences  in  the  depth  of 
sleep.  The  flitting  fancies  which  occupy  the  intro- 
duction and  the  termination  of  sleep,  rarely  possess 
any  power  to  fix  the  attention  or  to  linger  in  memory. 
But,  if  the  body  be  disturbed  by  anything  which 
causes  a  departure  from  the  even  course  of  health, 
such  as  follows  unusual  or  violent  emotion,  or  an  attack 


DREAMS.  135 

of  illness,  or  an  insufficient  alimentation,  or  great  and 
sudden  changes  of  atmospheric  pressure,  the  visions  of 
the  night  become  wonderfully  exaggerated  in  every 
particular.  During  a  voyage  at  sea,  while  suffering 
considerably  with  thirst,  one  night  I  dreamed  that  a 
fountain  of  sparkling  water  suddenly  appeared  before 
me.  A  young  girl  dipped  a  pitcher  in  the  flowing 
stream,  and  held  it  out,  all  dripping  with  delicious 
coolness,  for  me  to  drink.  Pressing  eagerly  forward, 
I  awoke,  to  find  myself  sitting  up  in  my  narrow  berth, 
with  hands  extended  for  the  draught.  Every  narrative 
of  shipwreck  is  filled  with  similar  experiences.  Slow 
starvation  is  always  accompanied  by  dreams  of  singu- 
lar intensity  and  persistence.  As  an  illustration  of  the 
corresponding  influence  of  previous  emotion,  I  may 
cite  the  experience  of  a  friend  who  had  been  greatly 
shocked  by  reading  the  account  of  the  manner  in 
which  the  lunatic.  Freeman,  had  killed  his  little  son  in 
imitation  of  Abraham's  contemplated  sacrifice  of 
Isaac.  This  gentleman  dreamed  that  he  was  about  to 
sacrifice  his  favorite  daughter.  He  called  her  to  him; 
told  her  that  he  was  about  to  cut  off  her  head  as  a 
religious  sacrifice ;  and  took  up  the  knife  for  that  pur- 
pose. She  exclaimed,  "  Oh,  papa!  I  have  never  diso- 
beyed you  yet  ! "  and  extended  her  neck,  to  receive  the 
fatal  stroke,  when  he  awoke,  trembling  in  every  limb, 
and  drenched  with  perspiration.  For  a  long  time  the 
horror  of  this  dream  affected  him  as  terribly  as  if  it 
had  been  an  actual  experience. 

It  is  usually  difficult  to  arrive  at  any  exact  estimate 
of  the  time  occupied  by  a  dream;  but  it  appears  cer- 
tain that  in  some  instances  the   succession  of  images 


136  INSOMNIA. 

excited  during  sleep  must  be  exceedingly  rapid.  Aber- 
crombie,  in  his  work  on  the  "  Intellecinal  Powers  and 
the  Investigation  of  Truth^''^  p.  275,  has  related  several 
illustrative  examples  of  this  fact.  In  my  own  experi- 
ence, one  night,  as  I  lay  half  asleep,  I  heard  the  watch- 
man on  his  round,  as  usual,  examining  the  fastenings 
of  my  front  door.  At  once  I  began  to  dream  that  I 
was  revisiting  my  father's  house,  the  home  of  my  child- 
hood. The  family  were  at  breakfast  in  the  front  par- 
lor, while  I  walked  through  the  back  rooms,  examin- 
ing the  doors  and  the  windows,  and  found  it  impossible 
to  close  and  to  fasten  them.  I  then  took  a  bath,  dressed 
myself,  and  walked  out  into  a  large  garden  behind  the 
house.  It  was  filled  with  tropical  trees,  of  which  some 
were  young.  The  old  ones,  which  I  recognized  after  an 
absence  of  thirty  years,  astonished  me  by  their  surprising 
luxuriance.  A  lovely,  trailing  convolvulus,  in  full  bloom, 
attracted  my  admiration.  After  walking  for  some  time 
I  came  upon  a  plum  tree  which  was  very  small  when  I 
left  home,  and  had  now  reached  a  height  not  exceed- 
ing twelve  feet.  This  slow  growth  excited  considera- 
ble surprise  on  my  part.  Eeturning  to  the  house,  I 
passed  the  day  with  my  parents,  and,  at  night,  under- 
took to  shut  up  the  house,  but  could  not  fasten  any  of 
the  doors  or  windows.  This  caused  me  great  uneasi- 
ness, for  there  was  a  large  gypsy  camp  not  far  from 
the  east  end  of  the  building.  My  anxiety  was  pres- 
ently justified  by  a  noise  in  the  parlor.  Hastening  to 
the  door,  and  looking  into  the  room,  I  saw  a  large 
painting  disappearing  through  a  hole  in  the  wall  next 
to  the  encampment  of  thieves.  I  immediately  cried 
out,  to  frighten  away  the  robbers;  and  was  awakened 


DREAMS.  137 

by  my  wife,  shaking  me,  and  asking  what  was  the  mat- 
ter, just  in  time  to  hear  the  watchman  walking  down 
the  front  steps,  after  the  completion  of  the  investiga- 
tion which  had  suggested  my  dream. 

Another  experience  may  serve  to  illustrate  the  fact 
that  dreams  are  greatly  intensified  by  illness,  and  that 
their  duration  may  be  exceedingly  brief.  Suffering, 
one  night,  from  an  attack  of  intestinal  colic,  marked 
by  a  rapid  succession  of  painful  paroxysms,  between 
which,  however,  I  fell  asleep  without  the  aid  of  medi- 
cine, I  dreamed  in  one  of  these  snatches  of  slumber 
that  I  was  walking  with  my  brother  on  the  road  to  the 
volcano  of  Kilauea.  In  my  hand  were  four  diamond 
shirt  buttons.  They  were  white,  and  were  covered 
with  fine  asbestos  wool.  My  brother's  wife  expressed 
serious  doubts  regarding  their  value;  but  I  at  once 
reminded  her  that  the  Emperor  of  China  had  given  to 
the  English  Ambassador,  for  presentation  to  the 
Queen  of  England,  a  number  of  diamonds  which  were 
so  rough  and  so  cheap  in  appearance  that  the  ambas- 
sador, who  was  also  a  marquis,  could  not  suppress  his 
contempt  as  he  received  the  gift.  But,  when  carried 
to  London,  and  cut  by  the  royal  jewelers,  their  brill- 
iance had  astonished  everyone.  I  now  desired  to  de- 
posit my  diamonds  with  a  jeweler,  for  safe-keeping. 
My  brother  recommended  a  house  near  the  volcano, 
but  I  had  seen  another,  a  few  squares  further  up  the 
road,  and  accordingly  resorted  thither.  Not  finding 
any  satisfactory  evidence  of  business,  I  retraced  my 
steps  to  the  place  first  recommended.  Entering  the 
door,  I  found  myself  in  a  narrow  room,  with  a  long, 
low  counter  on  one  side.     Behind  this  were  several 


138  INSOMNIA. 

men,  and  several  cases  filled  with  jewelry.  I  handed 
my  buttons  to  a  large,  good-looking  fellow,  who  was 
bustling  around  in  his  shirt-sleeves.  He  immediately 
put  one  of  the  jewels  into  his  mouth,  when  I  heard 
something  crack,  as  if  either  his  teeth  or  the  diamond 
had  split.  Consoling  myself  with  the  recollection  that, 
if  broken,  a  diamond  could  be  mended  with  cement,  I 
asked  for  a  certificate  of  deposit.  While  this  was  be- 
ing written,  the  entire  building  slipped  away  from  over 
us,  and  glided  down  the  slope  of  the  mountain,  towards 
the  ocean,  leaving  us,  and  all  that  had  been  within  the 
house,  uncovered  in  the  open  air.  This  did  not  discon- 
cert any  one.  The  jeweler  finished  his  writing  ;  I 
pocketed  the  receipt,  and  with  my  brother  pursued  our 
walk  through  the  mountain  forests  beyond  the  crater 
of  the  volcano.  Presently  we  arrived  at  an  eminence 
from  which  we  could  look  down  upon  the  ocean,  and 
could  see  the  line  of  the  coast  prolonged  for  many 
miles  on  either  side  of  a  cape  of  land.  The  western 
coast  was  very  grand — mountain  promontories  rising 
behind  each  other  as  far  as  the  eye  could  reach.  Hav- 
ing feasted  our  eyes  with  this  magnificent  panorama  of 
earth  and  sea  and  sky,  we  turned  away  in  the  direction 
of  a  grove,  in  which  was  visible  a  large  building  of 
stone,  with  castellated  walls,  and  turrets  with  pointed 
roofs  at  the  corners.  My  brother  informed  me  that 
this  was  a  German  settlement,  called  Little  Clacius. 
Approaching  the  castle,  we  were  received  in  a  mag- 
nificent hall  by  a  beautiful  woman  who  offered  to  con- 
duct us  through  the  building.  She  led  us  through  a 
series  of  lofty  rooms,  splendidly  painted,  gilded,  fres- 
coed,  and   furnished  with   inlaid  tables  and   polished 


DREAMS.  139 

chairs.  On  either  side  were  ranged  large  vases,  in 
which  grew  what  I  seemed  instinctively  to  recognize 
by  the  name  of  the  Lace  Mimosa — each  plant  consist- 
ing of  a  flat  sheet  of  green  lace-work,  like  a  coralline, 
studded  with  lovely  pale  yellow  blossoms.  Passing 
through  three  such  rooms,  we  entered  a  fourth,  across 
the  floor  of  which  our  fair  guide  whirled  herself  with 
a  pirouette  into  the  presence  of  a  young  woman  clad 
in  a  richly  figured  dressing-gown,  drawn  lightly  around 
her  form  as  she  sat  in  an  easy  chair,  nursing  her  baby. 
We  were  formally  introduced  to  this  lady,  who  received 
us  with  the  most  evident  indifference,  a  circumstance 
which  gave  us  no  concern,  for  the  view  from  the  open 
window  at  once  engrossed  my  attention.  Directly  be- 
fore me  was  a  shining  river,  pouring  down  the  moun- 
tain side  and  falling  about  fifteen  feet  into  a  deep  dark 
pool  that  widened  beneath  the  window  from  which  I 
gazed.  High  banks,  covered  with  magnificent  trees, 
sloped  down  into  the  water,  and  cast  their  shadows 
across  its  rippling  surface,  forming  a  most  charming 
landscape.  The  breadth  of  the  scene,  the  depth  of  the 
coloring,  the  perfection  and  the  multiplicity  of  all  the 
details  that  pressed  upon  the  attention,  could  not  have 
been  surpassed  in  vividness  by  any  real  existence.  I 
was  admiring  the  view,  and  was  beginning  to  feel  sur- 
prised that  so  large  a  river  could  exist  in  such  a  place, 
when  I  was  suddenly  awakened  by  a  renewal  of  the 
intermittent  pain. 

In  this  example  each  individual  detail  could  have 
been  easily  traced  to  its  source  in  memory.  Pictures, 
and  actually  existent  scenery  furnished  the  detached 
items  which  were  combined  in  a  brain  that  for  the  time 


140  INSOMNIA. 

being  was  released  from  the  control  of  tlie  reason  and 
the  will.  Irritated  hj  painful  sensations  the  brain  was 
inordinately  excitable,  and  sleep  was  less  profound. 
Hence  the  remarkable  intensity  of  the  pictures  which 
were  presented  to  the  eye  of  the  mind.  The  inde- 
scribable richness  and  variety  of  the  vision  was  prob- 
ably due  to  the  fact  of  extensive  bodily  disturbance, 
opening  a  wide  range  of  territory  from  which  impres- 
sions were  communicated  to  the  morbidly  sensitive 
brain.  The  unusual  permanence  of  the  whole  dream 
in  memory  may  be  explained  by  the  observation  of 
Maury,  that  the  ease  with  which  dreams  are  recollected 
varies  inversely  with  the  depth  of  the  sleep  in  which 
they  occur.  Dreams  which  are  produced  in  sound 
sleep  are  seldom  recalled  after  waking,  because  they 
are  but  slightly  connected  with  impressions  received 
by  the  brain  during  wakefulness. '  But  dreams  which 
occupy  the  mind  when  sleep  is  light  and  partial  are 
excited  by  cerebral  movements  which  are  closely  asso- 
ciated with  external  impressions  that  originate  either 
at  the  moment  of  awaking  or  immediately  after  that 
event;  consequently,  the  bond  of  union  between  the 
ideas  of  the  dream  and  our  waking  ideas  is  nearly  if 
not  quite  as  perfect  as  the  bonds  which  serve  to  con- 
nect the  thoughts  that  occupy  any  portion  of  our  con- 
scious life.  Hence  such  dreams  are  more  easily 
reproduced  from  memory  by  any  disposition  that 
arouses  a  retrograde  association  of  ideas. 

The  dream  above  related,  though  excited  by  an  un- 
healthy condition  of  the  body,  was  not  at  all  disagree- 
able.     But   it   is    often   the    case    that   disorders    of 

'A.  Maury,  Le  Sonimeil et  les  Reves.,  p.  219  et  seq. 


DREAMS.  141, 

particular  organs  serve  to  originate  visions  with  special 
and  evident  characteristics  related  to  their  source. 
Thus,  one  of  my  patients,  during  an  attack  of  uterine 
and  hemorrhoidal  congestion,  would  dream  that  a 
heavy  weight  had  been  laid  upon  the  lower  part  of  the 
abdomen.  On  another  occasion,  having  gone  to  sleep, 
apparently  in  perfect  health,  she  dreamed  of  a  terrible 
pain  in  the  head,  and  that  her  husband  and  a  physician 
were  applying  a  cupping  glass  to  the  back  of  her  neck. 
This  woke  her  up,  and  she  found  that  she  was  actually 
suffering  with  a  very  severe  headache.  Another  lady, 
shortly  after  confinement,  dreamed  that  her  baby  had 
teeth,  and  that  it  was  biting  her  nipple.  Next  day  she 
discovered  a  tender  spot  in  the  breast,  which  rapidly 
developed  a  mammary  abscess.  Forbes  Winslow  ^  has 
collected  a  considerable  number  of  similar  cases.  In 
certain  instances  not  only  have  dreams  been  originated 
by  special  local  pain,  but  the  incipient  stages  of  in- 
sanity have  been  revealed  by  exaggerated  dreams.  One 
of  my  patients,  for  a  considerable  time  before  the 
evolution  of  an  attack  of  melancholia,  would  dream, 
every  night,  that  a  big  black  dog  came  into  her  bed. 
Another,  who  suffered  with  cardiac  palpitation,  caused 
by  excessive  tea-drinking,  was  often  visited  in  sleep  by 
a  mocking  imp  who  seated  himself  upon  the  pit  of  her 
stomach,  and  pressed  her  ribs  together  with  his  hands. 
The  distress  or  alarm  which  accompanies  such 
dreams  is  sometimes  sufficient  to  arouse  the  sleeper. 
Often,  however,  he  strives,  in  his  vision,  to  escape 
from  some  impending  horror,  or  to  lift  up  his  voice  in 

*  Obscure  Diseases  of  the  Brain  and  Mind.       Philadelphia,  1866,  pp. 
394-398. 


142  INSOMNIA. 

a  cry  for  help,  but  the  will  is  powerless  to  reach  the 
necessary  muscles,  and  no  movement  results.  In  such 
cases  the  portion  of  the  brain  in  which  the  will  resides 
is  awake,  but  the  conducting  fibres  which  intervene 
between  the  cortex  of  the  brain  and  the  locomotive 
ganglia  in  the  cerebro-spinal  axis  are  asleep,  and  can- 
not be  sufficiently  aroused  to  transmit  the  impulses 
derived  from  the  action  of  the  will. 

In  all  ages  of  the  world  a  belief  in  the  prophetic 
character  of  certain  dreams  has  prevailed.  Numerous 
examples  are  recorded  in  which  a  warning  intimation 
of  approaching  disaster  has  been  thus  received.  Thus 
the  holy  evangelist,  St.  Matthew,  relates  that  Joseph, 
the  husband  of  Mary,  was  guided  by  dreams  to  escape 
with  his  family  from  the  murderous  designs  of  Herod 
and  of  his  son  Archelaus.  The  literature  of  the  mid- 
dle ages  is  filled  with  similar  narratives.  Coming 
down  to  recent  times,  it  is  not  difficult  to  gather  nu- 
merous examples  of  dreams  which  have  been  excited 
by  presentiments  of  good  or  evil.  A  lady  who  was 
about  to  embark  upon  the  ill-fated  steamer  Arctic, 
dreamed  so  vividly  of  shipwreck  that  she  refused  to 
take  passage,  and  thus  escaped  the  frightful  disaster 
which  overwhelmed  the  ship  and  its  numerous  passen- 
gers. Max  Simon'  relates  the  case  of  a  lady  who,  in 
spite  of  a  similar  warning,  embarked  upon  a  steamship 
and  lost  her  life,  through  the  explosion  of  the  boiler 
during  the  voyage.  On  another  occasion*  a  noble  lady 
dreamed  that  a  wing  of  the  palace  in  which  her  chil- 
dren were   sleeping  was   about  to  fall  down.      Starting 

'  Le  Monde  des  Reves,  p.  88. 
*  Op.  cif.,  p.  91. 


PROPHETIC   DREAMS.  143 

up,  she  called  her  waiting  maids,  and  insisted  that  they 
should  bring  the  children  to  her  chamber.  The  women 
endeavored  to  calm  her  agitation,  quoting  an  old 
proverb  to  the  effect  that  "  dreams  go  by  contraries." 
As  she  persisted  in  her  commands,  they  feigned  obedi- 
ence, but  soon  returned  to  say  that  the  young  princes 
were  sleeping  too  quietly  to  be  removed.  The  princess 
would  not  be  thus  composed;  and  at  last  .he  servants 
reluctantly  brought  the  little  boys  from  their  room. 
They  had  scarcely  reached  their  mother's  apartments, 
when  the  disaster  of  which  she  had  dreamed  was  real- 
ized, and  the  bedroom  from  which  they  had  just  been 
carried,  was  crushed  into  a  mass  of  ruins. 

The  ancient  explanation  of  sUch  events  consisted  in 
a  reference  to  the  Deity,  who  was  supposed  to  address 
his  favorites  through  the  medium  of  dreams.  The 
modern  skeptical  explanation  views  all  such  revelations 
as  mere  accidents.  Among  the  myriads  of  dreamers, 
say  the  "  five-sense  philosophers,"  the  infinite  variety 
of  combinations  which  disturb  the  brain  during  sleep, 
cannot  fail  to  produce  occasionally  such  coincidences. 
When  these  are  of  a  striking  character,  the  seemingly 
prophetic  vision  is  remembered,  but  the  cases  of  dis- 
crepancies between  vision  and  result  are  not  recorded, 
and  are  soon  forgotten.  This  opinion  may  very  prob- 
ably be  correct  in  the  vast  majority^ of  instances;  but,  if 
so,  we  are  not  in  a  position  to  assert  any  scientific 
demonstration  of  the  fact.  There  is,  moreover,  so  far 
as  the  ancient  religious  view  is  concerned,  a  certain 
transcendental  sense  in  which  it  is  true  that  God  may 
guide  his  creatures  through  the  agency  of  dreams,  as 
well  as  in  a  thousand   other   different   ways;  but  this 


144  INSOMNIA. 

metaphysical  process  we  can  no  more  comprehend  than 
we  can  understand  or  explain  the  interaction  of  mind 
and  matter  in  the  brain.  The  psycho-physiologist 
must  content  himself,  at  present,  with  the  attempt  to 
show  that  it  may  not  be  incompatible  with  natural  law 
for  coming  events  to  cast  their  shadows  before  them 
through  the  forms  of  a  dream.  The  following  obser- 
vations lend  color  to  such  a  possibility. 

The  extraordinary  susceptibility  of  the  brain  during 
certain  conditions  of  sleep  has  already  been  noted  as  a 
cause  for  the  superior  vividness  of  coloring  and  inten- 
sity   of     action    which    sometimes     characterizes    our 
dreams.     In  this  respect  a  slightly  morbid  condition 
of  the  brain,   comparable  to  the  effects  of  hasheesh, 
probably  exists.     In  such  cases  the  brain  may  be  dis- 
turbed to  a  degree  sufficient  for  the  awakening  of  con- 
sciousness by  causes  that  would  ordinarily  be  power- 
less to  reveal  themselves.     Kecording  his  experience  of 
an    earthquake    at  Lesina,   in  the   night   of   Sept.    8, 
1884,  Buschick  states,  in  the  Journal  of  the  Austrian 
Meteorological   Society,  that  a  few  seconds  before  the 
shock  he  was  awakened  with  a  feeling  of  strange  dis- 
comfort and  apprehension.      Once  before,  on  a  similar 
occasion,   he   had  been  in  like  manner   aroused   from 
sleep  just  before  the  commencement  of  an  earthquake, 
probably  by  a  feeble  and  ordinarily  imperceptible  agi- 
tation of  the   soil.      At  a  time  when  I  was  for  many 
months   severely  overtasked,  I  always  woke  up  in  the 
night  whenever   about  to  receive  a  call   to  a  patient. 
Before  the  sound  of  footsteps   became   audible  on  the 
sidewalk,  I  would  wake.     Presently  some   one  would 
be  heard,  approaching  the  house,  and  then  the  door- 


DREAMS.  145 

bell  would  ring.  So  often  was  this  experience  repeated, 
that  I  learned  to  expect  a  summons  whenever  awak- 
ened during  the  night.  Gradually,  however,  as  my 
health  improved  with  rest,  this  morbid  excitability  dis- 
appeared, and  has  never  been  renewed.  It  seems  prob- 
able that  in  this  example  the  sensitiveness  of  the  brain 
during  sleep  was  so  great  that  audible  impressions 
were  received  with  vigor  sufficient  to  awake  conscious- 
ness before  they  were  sufficiently  strong  to  arrest  the 
attention  when  actually  awake.  The  extreme  sensibil- 
ity of  the  brain,  under  certain  conditions,  to  impress- 
ions from  a  distance,  is  further  illustrated  by  the  expe- 
rience of  persons  laboring  under  diseases  which 
produce  serious  departures  from  a  healthy  cerebral 
circulation.  Thus,  one  of  my  patients,  while  suJGPering 
with  cerebral  hypersemia,  could  hear  children  talking 
half  a  mile  away,  at  a  distance  where  no  one  else  could 
hear  them.  This  susceptibility  is  doubtless  the  founda- 
tion of  many  well  authenticated  cases  of  presentiment. 
Another  of  my  patients,  a  lady  of  remarkably  sensitive 
nervous  organization,  though  otherwise  in  apparently 
good  health,  was  one  evening  lying  alone  upon  her  bed. 
Suddenly,  she  became  greatly  agitated  with  the  convic- 
tion that  something  had  happened  to  her  husband,  who 
had  not  yet  returned  from  his  place  of  business.  He 
presently,  however,  came  quietly  into  the  house,  and 
greeted  his  wife  as  usual.  She  exclaimed  at  once, 
"What  has  happened  to  you,  my  dear?"  "Nothing," 
he  replied.  "Yes,"  she  said,  "something  has  hap- 
pened, just  now;  I  felt  that  you  were  in  trouble."  "Oh, 
yes,"  answered  he,  after  a  moment's  reflection,  "as  I 
was  passing  by  the  park,  on  my  way  home,  two  men 
10 


146  INSOMNIA. 

tried  to  stop  my  horse,  but  I  whipped  up,  and  got  away 
from  them  without  any  trouble." 

On  another  occasion  the  same  patient  was  one  day 
suddenly  oppressed  by  a  conviction  that  something  had 
happened  to  her  mother  and  sister,  who  were  driving 
together  at  some  distance  from  home.  After  a 
short  time  they  actually  returned  in  a  sorry  plight, 
without  their  carriage.  The  horse  had  run  away,  up- 
setting them  upon  the  road. 

In  all  these  cases  it  is  worthy  of  remark  that  there 
was  present  an  unusual  degree  of  cerebral  erethism. 
Solicitude,  weariness,  anxiety,  inordinate  irritability  of 
the  brain.  It  is  possible  that  under  such  conditions 
one  may  hear  premonitory  sounds,  may  in  some  sort 
feel  distant  agitations  which  our  healthy  organs  are 
usually  incapable  of  apprehending.  When  such  a 
brain  during  sleep  is  unoccupied  with  the  ordinary 
objects  of  sensation,  feeble  impulses,  which  usually 
remain  unnoticed,  may  sometimes  suffice  to  arrest  the 
attention.  We  may  thus  explain  the  possibility  of 
impressions  derived  from  distant  events  passing  into 
the  consciousness  of  a  dreamer,  and  arousing  halluci- 
nations of  which  the  immediate  cerebral  mechanism  is 
the  same  as  that  of  the  ordinary  hypnagogic  halluci- 
nation. Thus,  the  Rev.  Canon  Warburton  relates  the 
following  experience ' : 

"Somewhere  about  the  year  1848  I  went  up  from 
Oxford  to  stay  a  day  or  two  with  my  brother. 
When  I  got  to  his   chambers    I   found  a  note  on  the 
table  apologising  for  his  absence,  and  saying  that  he 
had  gone  to  a  dance  somewhere  in  the  West  End,  and 

'  The  Nineteenth  Coitury,  July,  18S4.  p.  71. 


CLAIRVOYANT   DREAMS.  147 

intended  to  be  home  soon  after  one  o'clock.  Instead 
of  going  to  bed,  I  dozed  in  an  arm-chair,  but  started 
np  wide  awake  exactly  at  one,  ejaculating,  '  By  Jove, 
he's  down!'  and  seeing  him  come  out  of  a  drawing- 
room  into  a  brightly  illuminated  landing,  catching  his 
foot  in  the  edge  of  the  top  stair,  and  falling  headlong, 
just  saving  himself  by  his  elbows  and  hands.  (The 
house  was  one  which  I  had  never  seen,  nor  did  I  know 
where  it  was.)  Thinking  very  little  of  the  matter,  I 
fell  a-doze  again  for  half  an  hour,  and  was  awakened 
by  my  brother  suddenly  coming  in  and  saying,  '  Oh, 
there  you  are !  I  have  just  had  as  narrow  an  escape 
of  breaking  my  neck  as  I  ever  had  in  my  life.  Com- 
ing out  of  the  ball-room,  I  caught  my  foot,  and 
tumbled  full  length  down  the  stairs.' " 

An  incident  of  this  character  might  very  properly 
be  ranked  as  a  mere  coincidence,  were  it  not  for  the 
fact  that  it  is  one  only  of  a  considerable  number  of 
well  attested  acts  of  vision  connected  either  with  the 
hypnagogic  state  or  with  the  act  of  dreaming  itself. 
The  comparative  rarity  of  such  events  lends  them  a 
marvelous  aspect;  yet  there  is  really  nothing  about 
them  any  more  wonderful  or  preternatural  than  the 
demonstrated  possibility  of  telegraphic  signaling  across 
the  sea  without  the  intervention  of  an  electric  wire.' 
Under  ordinary  circumstances  a  metallic  conductor 
must  serve  as  the  avenue  of  communication  between 
distant  stations;  but  if  a  sufficiently  sensitive  piece  of 
apparatus  be  placed  in  contact  with  the  water  on  either 
side  of  an  arm   of   the   sea,   communications   may  be 

^Nature,  October,  i6,  1884,  p.  596. 


148  INSOMNIA. 

transmitted  from  one  to  the  other  by  a  diffusion  of  im- 
pulses through  the  entire  body  of  water. 

In  like  manner  we  ordinarily  see  and  hear  and  feel 
as  a  consequence  of  cerebral  excitement  occasioned  by 
specific  impressions  concentrated  through  the  organs 
of  sight  and  hearing  and  touch.  But  it  is  quite  reason- 
able to  believe  in  the  possible  existence  of  a  brain  so 
delicately  organized  as  to  be  capable  of  reacting  to  im- 
pressions which  are  too  diffuse  and  too  feeble  to  arouse 
the  ordinary  apparatus  of  sensation.  With  such  a 
brain  it  might  be  possible  to  experience  perception 
without  eye-sight.  Evidence  furnished  by  the  facts 
of  somnambulism  and  hypnotism  indicates  that  the 
receptivity  of  the  brain  may  become  temporarily  ex- 
alted to  a  degree  which  warrants  the  inference  that 
clairvoyance  itself  may  be  thus  brought  within  the 
capacity  of  certain  peculiarly  sensitive  organizations. 
The  same  extraordinary  receptivity  occasionally  seems 
to  attend  the  act  of  dreaming.  For  example,  one  of 
my  acquaintances,  a  lady  of  a  highly  wrought  nervous 
temperament,  the  wife  of  a  distinguished  physician  in 
a  neighboring  State,  dreamed  one  night  that  a  favorite 
cousin,  a  beautiful  little  girl,  who  lived  at  a  distance 
of  twelve  or  fifteen  miles,  was  very  dangerously  ill. 
She  saw  the  child  lying  on  its  mother's  lap,  evidently 
at  the  point  of  death,  when  some  one  brought  a  tub  of 
warm  water  and  proceeded  to  give  the  patient  a  bath. 
This  revived  the  little  one  so  that  she  recovered.  The 
dream  made  a  very  considerable  impression  upon  my 
friend,  by  reason  of  its  peculiar  character,  and  because 
dreaming  was  for  her  a  very  unusual  experience.  Next 
morning  she  rose  as  usual,  but  during  the  forenoon 


CLAIRVOYANT   DREAMS.  149 

she  was  startled  by  the  receipt  of  a  message  request- 
ing her  to  come  at  once  to  the  house  of  her  nncle,  as 
his  little  daughter  had  been  taken  suddenly  ill  with  the 
croup,  and  had  expired  during  the  preceding  night. 
Hastening  to  the  bereaved  household,  she  found  her 
aunt  sitting  with  the  dead  child  on  her  lap,  precisely 
as  she  had  appeared  in  the  dream.  The  little  girl  had 
been  suddenly  attacked  during  the  night,  and,  as  she 
lay  gasping  in  her  mother's  arms,  some  one  advised  a 
warm  bath,  and  brought  a  tub  of  water  into  the  room 
for  that  purpose.  Unfortunately,  just  as  they  were 
hopefully  preparing  to  dip  the  child  into  the  water, 
she  had  ceased  to  breathe. 

The  lack  of  conformity  between  the  conclusion  of 
this  dream  and  the  actual  fact  reminds  one  of  the 
blurring  of  the  images  that  are  transferred  from  one 
brain  to  another  in  the  acts  of  telepathy  recently  in- 
vestigated by  the  Society  for  Psychical  Research. 
Something  similar  is  frequently  observed  in  connec- 
tion with  the  phenomena  of  hypnotism.  The  hypno- 
tised subject  does  not  always  perceive  clearly  or  wholly 
the  sensation  that  is  suggested  by  the  agent  who 
operates  upon  his  brain. 

For  another  example  of  apparently  clairvoyant 
dreaming,  I  am  indebted  to  a  friend,  a  well-known 
gentleman  of  unimpeachable  veracity,  who,  when  a 
young  man  in  the  army,  during  the  war  of  the  great 
rebellion,  was  taken  very  ill,  and  was  sent  home  to 
New  England  from  one  of  the  most  remote  outposts  of 
the  campaign.  No  one  of  his  family  had  the  slightest 
information  or  suspicion  of  his  illness,  until  the  night 
before  his  arrival,  when  his  father  dreamed  that  the  ab- 


150  INSOMNIA. 

sent  son  was  sick,  and  would  arrive  the  next  day,  at  an 
hour  unusual  for  travelers  coming  from  the  South.  So 
vivid  was  this  di'eam,  and  so  powerful  was  its  influence 
upon  the  mind  of  the  dreamer,  that  he  went  at  the 
specified  hour  to  the  railway  station,  with  a  carriage 
full  of  blankets  and  pillows,  to  receive  his  son.  When 
the  train  arrived,  and  the  invalid  actually  appeared, 
the  mutual  astonishment  of  father  and  son  can  better 
be  imagined  than  described. 

In  a  recent  work  on  hypnotism,'  Fischer  has  related 
several  personal  experiences  of  a  similar  transfer  of 
impressions  during  the  waking  state.  It  is  highly 
probable  that  if  such  impressions  are  received  by  a 
sleeping  brain,  they  may  operate  like  other  suggestive 
irritants  to  produce  dreams,  which  may  be  sometimes 
so  vigorously  projected  upon  the  consciousness  of  the 
dreamer  that  he  may  be  awakened,  and  may  still  per- 
ceive the  evolution  of  his  dream  as  an  hallucination, 
even  after  waking.  Thus,  on  one  occasion,  during  a 
malarial  fever,  I  dreamed  of  seeing  a  friend  who  lived 
at  a  great  distance.  So  vivid  was  the  impression  that 
I  started  up  awake;  and  there,  at  the  foot  of  the  bed. 
in  broad  daylight,  was  my  friend,  looking  calmly  at  me. 
Several  seconds,  at  least,  were  required  to  dissipate  the 
vision.  In  an  article  already  quoted,"  Sir  Edmund 
Hornby,  late  Chief  Judge  of  the  Supreme  Consular 
Court  of  China  and  Japan,  "  who  describes  himself  as 
'  a  lawyer  by  education,  family,  and  tradition,  wanting 
in   imagination,  and  no  believer  in  miracles,'  "  relates 

'  Lebensmagnetismus  oder  Hypnotisinus,  von    Dr.  E.  L.  Fischer,  pp. 

71-73- 

'^  71ie  Nineteenth  Century,  July,  1884,   p.  89. 


HALLUCIXATIONS.  151 

his  experience  of  a  similar  spectral  visitation.  After 
stating  that  "it  was  his  habit  at  Shanghai  to  allow 
reporters  to  come  to  his  house  in  the  evening,  to  get 
his  written  judgment  for  the  next  day's  paper,"  he 
sajs: 

"  They  generally  availed  themselves  of  the  oppor- 
tunity, especially  one  reporter,  who  was  also  the  editor 
of  an  evening  paper.  He  was  a  peculiar  man,  reticent 
about  himself,  and  I  imagine  had  a  history.  In  ap- 
pearance he  was  also  peculiar.  I  only  knew  him  as  a 
reporter,  and  had  no  other  relations  with  him.  On  the 
day  when  the  event  occurred,  in  1875  or  1876,  I  went 
to  my  study  an  hoiu^  or  two  after  dinner,  and  wrote  out 
my  judgment.  It  was  then  about  half -past  eleven.  I 
rang  for  the  butler,  gave  him  the  envelope,  and  told 
him  to  give  it  to  the  reporter  who  should  call  for  it. 
I  was  in  bed  before  twelve.  I  am  a  very  light  sleeper, 
and  my  vtdfe  a  very  heavy  one.  Indeed,  it  is  difficult 
to  rouse  her  out  of  her  first  sleep.  The  bed — a  French 
one — faced  the  fire-place ;  on  the  mantel-piece  was  a 
clock,  and  the  gas  in  the  chandelier  was  turned  down, 
but  only  so  low  as  to  admit  of  my  seeing  the  time  at 
any  time  of  the  night,  for  —  waking  easily  and  fre- 
quently— I  often  smoked  a  cigarette  before  I  went  to 
sleep  again,  and  always  desired  to  know  the  hour. 

"  I  had  gone  to  sleep,  when  I  was  awakened  by 
hearing  a  tap  at  the  study  door,  but  thinking  it  might 
be  the  butler — looking  to  see  if  the  fire  were  safe  and 
the  gas  turned  off — I  turned  over  with  the  view  of 
getting  to  sleep  again.  Before  I  did  so,  I  heard  a 
tap  at  my  bed-room  door.  Still  thinking  it  might  be 
the  butler,  who  might   have   something  to  say,  I  said, 


152  INSOMNIA. 

*  Come  in.'  The  door  opened,  and,  to  my  surprise,  in 
walked  Mr. .  I  sat  up  and  said,  '  You  have  mis- 
taken the  door ;  but  the  butler  has  the  judgment,  so  go 
and  get  it.'     Instead  of  leaving  the  room  he  came  to 

the  foot  edge  of  the  bed.     I  said, '  Mr. ,  you  forget 

yourself!  Have  the  goodness  to  walk  out  directly. 
This  is  rather  an  abuse  of  my  favor.'  He  looked 
deadly  pale,  but  was  dressed  in  his  usual  dress,  and 
was  certainly  quite  sober,  and  said,  '  I  know  that  I  am 
guilty  of  an  unwarrantable  intrusion,  but  finding  that 
you  were  not  in  your  study  I  have  ventured  to  come 
here.'  I  was  losing  my  temper,  but  something  in  the 
man's  manner  disinclined  me  to  jump  out  of  bed  to 
eject  him  by  force.  So  I  said,  simply,  '  This  is  too 
bad,  really;  pray,  leave  the  room  at  once.'  Instead  of 
doing  so  he  put  one  hand  on  the  foot-rail,  and  gently, 
and  as  if  in  pain,  sat  down  on  the  foot  of  the  bed.  I 
glanced  at  the  clock,  and  saw  that  it  was  about  twenty 
minutes  past  one.  I  said,  '  The  butler  has  had  the 
judgment  since  half -past  eleven ;  go  and  get  it.'  He  said, 
'  Pray  forgive  me ;  if  you  knew  all  the  circumstances, 
you  would.  Time  presses.  Pray  give  me  a  precis  of  your 
judgment,  and  I  will  take  a  note  in  my  book  of  it,' 
drawing  his  reporter's  book  out  of  his  breast  pocket. 
I  said,  '  I  will  do  nothing  of  the  kind.  Go  down  stairs, 
find  the  butler,  and  don't  disturb  me — ^you  will  wake 
my  wife — otherwise  I  shall  have  to  put  you  out  ?'  He 
slightly  moved  his  hand.  I  said,  '  Who  let  you  in  ? ' 
He  answered,  '  No  one.'  '  Confound  it,'  I  said,  '  What 
the  devil  do  you  mean?  Are  you  drunk?'  He  replied, 
'  No,  and  never  shall  be  again ;  but  I  pray  your  lord- 
ship give  me  your  decision,  for  my  time  is  short.'     I 


EXPERIENCE   OF   SIR  E    HORNBY.  153 

said,  *  You  don't  seem  to  care  about  my  time,  and  this 
is  the  last  time  I  will  ever  allow  a  reporter  in  my 
house.'  He  stopped  me  short,  saying,  '  This  is  the  lasi 
time  I  shall  ever  see  you  anywhere.' 

"  "Well,  fearful  that  this  commotion  might  arouse 
and  frighten  my  wife,  I  shortly  gave  him  the  gist  of 
my  judgment  in  as  few  words  as  I  could.  He  seemed 
to  be  taking  it  down  in  short-hand;  it  might  have 
taken  two  or  three  minutes.  When  I  finished,  he  rose, 
thanked  me  for  excusing  his  intrusion  and  for  the  con- 
sideration I  had  always  shown  him  and  his  colleagues, 
opened  the  door  and  went  away.  I  looked  at  the 
clock ;  it  was  on  the  stroke  of  half -past  one. 

( Lady  Hornby  now  awoke,  thinking  she  had 
heard  talking;  and  her  husband  told  her  what  had 
happened,  and  repeated  the  account  when  dressing 
next  morning.)' 

"  I  went  to  the  court  a  little  before  ten.  The  usher 
came  into  my  room  to  robe  me,  when  he  said,  '  A  sad 

thing  happened  last  night,  sir.     Poor was  found 

dead  in  his  room.'  I  said,  'Bless  my  soul!  dear  me! 
What  did  he  die  of,  and  when  ? '  '  Well,  sir,  it  appears 
he  went  up  to  his  room  as  usual  at  ten  to  work  at  his 
papers.  His  wife  went  up  about  twelve  to  ask  him 
when  he  would  be  ready  for  bed.  He  said,  "  I  have 
only  the  judge's  judgment  to  get  ready,  and  then  I 
have  finished."  As  he  did  not  come,  she  went  up  again, 
about  a  quarter  to  one,  to  his  room  and  peeped  in,  and 
thought  she  saw  him  writing,  but  she  did  not  disturb 
him.  At  half-past  one  she  again  went  to  him  and 
spoke  to  him  at  the  door.  As  he  did  not  answer  she 
thought  he  had  fallen  asleep,  so  she  went  up  to  rouse 


154  .      INSOMNIA. 

liim.  To  her  horror  he  was  dead.  On  the  floor  was 
his  note  book,  which  I  have  brought  away.  She  sent 
for  the  doctor,  who  arrived  a  little  after  two,  and  said 
he  had  been  dead,  he  concluded,  about  an  hour.'  I 
looked  at  the  note  book.  There  was  the  usual  head- 
ing- 

"  '  In  the  Supreme  Court,  before  the  Chief  Judge. 

V. 

"  '  The  Chief  Judge  gave  judgment  this  morning  in 
this  case  to  the  following  effect' — and  then  followed  a 
few  lines  of  indecipherable  shorthand. 

*'  I  sent  for  the  magistrate  who  would  act  as  coro- 
ner, and  desired  him  to  examine  Mr. 's  wife  and  ser- 
vants as  to  whether  Mr. had  left  his  home,  or  could 

possibly  have  left  it  without  their  knowledge,  between 
eleven  and  one  on  the  previous  night.  The  result  of 
the  inquest  showed  he  died  of  some  form  of  heart  dis- 
ease, and  had  not,  and  could  not  have  left  the  house 
without  the  knowledge  of  at  least  his  wife,  if  not  of  his 
servants.  Not  wishing  to  air  my  'spiritual  experience' 
for  the  benefit  of  the  press  or  the  public,  I  kept  the 
matter  at  the  time  to  myself,  only  mentioning  it  to  my 
Puisne  Judge  and  to  one  or  two  friends ;  but  when  I 
got  home  to  tiffin  I  asked  my  wife  to  tell  me  as  nearly 
as  she  could  remember  what  I  had  said  to  her  during 
the  night,  and  I  made  a  brief  note  of  her  replies  and 
of  the  facts. 

"  As  I  said  then,  so  I  say  now — I  was  not  asleep. 
but  wide  awake.  After  a  lapse  of  nine  years  my 
memory  is  quite  clear  on  the  subject.  I  have  not  the 
least  doubt,  I  saw  the  man — -have  not  the  least  doubt 
that  the  conversation  took  place  between  us. 


EXPERIEXCE   OF   SIR  E.    HORNBY.  155 

"I  may  add  that  I  had  examined  the  butler  in  the 
morning — who  had  given  me  back  the  MS.  in  the  en- 
velope when  I  went  to  the  court  after  breakfast — as  to 
whether  he  had  locked  the  door  as  usual,  and  if  any  one 
could  have  got  in.  He  said  that  he  had  done  every- 
thing as  usual,  adding  that  no  one  could  have  got  in  if 
even  he  had  not  locked  the  door,  as  there  was  no  handle 
outside — which  there  was  not.  I  examined  the  coolies 
and  other  servants,  who  all  said  they  opened  the  door 
as  usual  that  morning — turned  the  key  and  undid  the 
chains,  and  I  have  no  doubt  they  spoke  the  truth.  The 
servants'  apartments  were  separated  from  the  house, 
but  communicated  with  it  by  the  gallery  at  the  back, 
some  distance  from  the  entrance  hall. 

"  The  reporter's  residence  was  about  a  mile  and  a 
quarter  from  where  I  lived,  and  his  infirmities  pre- 
vented him  from  walking  any  distance  except  slowly; 
in  fact,  he  almost  invariably  drove. 

"Edmund  Hoenby." 

The  publication  of  this  remarkable  story  led  to  its 
correction  in  several  important  particulars.  From  the 
North  China  Herald  (August,  1884)  it  appears  that 
not  only  was  Sir  Edmund's  memory  defective  in  con- 
nection with  several  of  the  minor  details  of  the  narra- 
tive, but  he  had  also  been  either  wholly  misinformed, 
or  was  quite  forgetful  regarding  the  actual  time  of  the 
editor's  death.  That  person  was,  in  fact,  alive  and  in 
his  usual  health  at  the  time  of  his  supposed  apparition 
in  the  judge's  chamber,  and  did  not  die  till  between 
eight  and  nine  o'clock  on  the  same  morning.  He  had 
"  attended  a  temperance  committee  meeting  the  night 
before,  and  had  left  about  half -past  ten  in  good  health 


156  INSOMNIA. 

and  excellent  spirits.  .  .  .  He  slept  at  home,  rose 
shortly  before  eight,  and  visited  his  office  to  arrange 
some  matter  for  that  day's  paper.  He  then  returned 
to  his  room  to  dress,  and  in  a  few  minntes  afterward 
was  found  dead  upon  the  floor." 

Between  these  conflicting  witnesses  it  is  of  course 
impossible  to  decide.  But  for  our  purpose  that  is  quite 
unnecessary.  It  is  clear  that  Sir  Edmund  believed 
that  the  visible  image  of  an  acquaintance  had  appeared 
before  him  in  his  chamber  at  night.  It  is  also  evident 
that  the  judge  was  a  man  whose  nerves  had  been  dam- 
aged, probably  by  tobacco — for  he  was  a  "light  sleeper" 
— waking  often,  and  indulging  in  the  luxury  of  a  cigar- 
ette during  the  course  of  the  night.  If  we  may  credit 
the  writer  in  the  Herald,  his  brain  was  in  a  process  of 
deterioration,  proved  by  the  decidedly  treacherous 
character  of  his  memory.  The  whole  story,  therefore, 
becomes  exceedingly  instructive  as  an  illustration  of 
the  manner  in  which  a  belief  in  apparitions  may  be 
originated.  The  most  probable  explanation  of  the  in- 
cident is  found  in  the  hypothesis  of  a  dream  excited  in 
an  irritable  brain  that  had  been  aroused  by  the  prepa- 
ration of  the  manuscript  which  had  occupied  the 
thoughts  of  the  judge  immediately  before  retiring  for 
the  night.  The  course  of  this  dream  was  so  vivid  that 
the  sleeper  awoke,  but  continued,  like  some  other 
dreamers  similarly  awakened,  to  witness  the  evolution 
of  his  vision  in  the  form  of  a  genuine  hallucination. 
A  remarkable  example  of  a  similar  production  of  hal- 
lucination through  disease  of  the  brain  is  related  by 
the  late   Dr.  E.  H.   Clarke.'     One   of  his   patients,  a 

'  Visions:     A   Stiidy  of  False  Sight ,  p.  39. 


HALLUCINATIONS.  157 

vigorous  old  gentleman,  of  eighty  years,  a  great  lover 
of  music,  and  a  frequent  attendant  at  operas  and  con- 
certs, retired  one  night  at  the  usual  hour,  and  in  his 
usual  health.  He  soon  fell  asleep,  "  and  slept  well  till 
about  two  A.  M.,  when  he  was  awakened  by  the  sound 
of  music,  which  seemed  to  come  from  the  street  near 
his  house.  Thinking  a  serenade  was  going  on,  he  got 
up  to  ascertain  where  it  was,  but  discovered  nothing. 
The  sound  ceased  when  he  arose.  On  returning  to 
bed,  he  heard  the  sound  of  music  again,  and  was  at  the 
same  time  surprised  by  the  appearance  of  three  per- 
sons, standing  near  each  other  in  his  chamber,  opposite 
the  foot  of  his  bed.  It  was  his  habit  to  sleep  with  the 
gaslight  burning  feebly,  near  the  head  of  his  bed.  He 
turned  the  gas  on  to  its  full  power,  and  inspected  the 
intruders.  They  appeared  to  be  musicians,  who  were 
humming  and  singing,  as  if  in  preparation  for  a  musi- 
cal performance.  He  rang  a  bell,  which  summoned  his 
man  servant.  John  soon  arrived,  and  was  ordered  to 
put  the  strangers  out.  '  There  is  nobody  here,  sir,' 
was  John's  reply  to  the  order.  For  a  moment  Mr.  A. 
was  not  only  amazed,  but  alarmed.  '  What ! '  he  ex- 
claimed, 'do  you  see  no  one  there?'  'No  one,'  said 
John.  'Go  where  those  chairs  are,  and  move  them,' 
was  Mr.  A.'s  next  direction.  John  did  so.  The 
strangers  stepped  aside,  but  did  not  go  out.  By  this 
time  Mr.  A.  had  gathered  his  wits  about  him,  and  was 
satisfied  that  he  was  the  victim  of  a  hallucination;  and 
he  determined  to  observe  its  phenomena  carefully. 
Accordingly,  he  bade  his  servant  depart,  and  prepared 
to  watch  his  visitors.  But  they  were  so  life-like  and 
human,  that  he   was   again   staggered,    and  recalling 


158  INSOMNIA. 

John,  told  him  to  go  for  the  house-keeper.  She  soon 
came,  and  on  being  interrogated,  confirmed  John's 
statements  that  there  were  no  strangers  in  the  chamber 
and  no  sounds  to  be  heard.  Convinced  by  the  testi- 
mony of  two  witnesses,  Mr.  A.  yielded  to  the  decision 
of  his  reason,  and  again  resolved  to  go  on  with  the  in- 
vestigation of  the  strange  phenomena.  The  musicians 
had  now  resumed  their  position,  near  the  window  and 
opposite  the  foot  of  the  bed.  Mr.  A.  turned  the  light 
of  the  gas  full  upon  them.  He  looked  at  his  watch, 
which  marked  the  hour  of  half -past  two.  He  then  ar- 
ranged his  pillows,  so  as  to  sit  almost  upright  in  bed, 
and  waited  for  the  next  scene  of  the  play.  He  was 
able  to  note  the  size,  form,  dress,  and  faces  of  the  per- 
formers. One  was  a  large  man,  who  bore  some  resem- 
blance to  Brignoli.  The  two  others  were  of  less  size, 
and  shorter  stature  than  their  companions.  All  were 
habited  in  dress  coats,  with  white  waist  coats,  and  wore 
white  cravats  and  white  gloves.  After  a  little  time 
spent  in  coughing  and  clearing  their  throats,  they 
began  to  sing.  They  sang  at  first  a  few  simple  airs, 
'  Sweet  Home '  among  others.  They  then  attempted 
more  difficult  music,  and  gave  selections  from  Beetho- 
ven and  Mozart.  Between  the  pieces  they  chatted  with 
each  other  in  a  foreign  language,  which  Mr.  A.  took  to 
be  Italian,  but  they  did  not  address  him.  Occasionally 
they  changed  their  position,  turned  in  various  direc- 
tions, and  part  of  the  time  sat  down.  Mr.  A.  said  the 
singing  was  excellent;  he  had  rarely  heard  better. 
After  the  first  feeling  of  surprise  and  amazement  had 
passed  away,  he  enjoyed  the  music  exceedingly.  The 
performance  continued  in  this  way  for  some  time,  when 


REVELATION.  159 

it  suddenly  came  to  an  end.  The  singing  ceased,  and 
the  singers  vanished.  He  looked  at  his  watch,  and 
found  that  the  time  was  four  o'clock.  The  concert  in 
his  brain  had  lasted  nearly  an  hour  and  a  half,  almost 
the  length  of  an  ordinary  concert.  He  reflected  for  a 
while  upon  this  strange  occurrence,  but  not  being  able 
to  arrive  at  any  satisfactory  explanation  of  it,  he  turned 
his  gas  down  and  went  to  sleep.  The  next  morning  he 
called  at  my  office,  as  previously  stated,  to  ascertain  if 
possible  what  pranks  his  brain  had  been  playing,  and 
if  he  should  regard  them  as  warning  of  his  approach- 
ing departure." 

In  this  case  the  patient  was  suffering  from  "  a  mod- 
erate degree  of  deafness,  persistent  tinnitus  aurium, 
occasional  vertigo,  and  slight  loss  of  memory."  To- 
wards the  close  of  life,  two  or  three  years  later,  "inco- 
herence, delirium,  stupor,  and  the  like,  indicated  with 
sufficient  certainty  the  presence  of  severe  cerebral  dis- 
ease." The  remarkable  hallucination  which  he  experi- 
enced was  undoubtedly  the  product  of  the  morbid 
changes  which  were  progressing  in  his  brain. 

These  cases  form  an  ascending  series  which  illus- 
trates the  receptive  and  constructive  capacities  of  the 
human  brain  when  its  sensory  apparatus  has  become 
unusually  or  morbidly  excitable.  But  this  preter- 
natural mobility  may  display  itself  in  other  depart- 
ments besides  those  of  mere  sense-perception.  The 
sphere  of  pure  intellect  may  thus  be  invaded  by  ideas 
springing  from  impressions  which  address  the  reason- 
ing faculties  alone,  so  that  in  sleep  a  dream  may  lead 
the  judgment  to  decisive  conclusions  that  were  scarcely 
recognized  or  heeded  during  the  hours  of  wakefulness. 


160  INSOMNIA. 

In  this  way  we  may  learn  to  understand  how  the 
anxieties  experienced  by  the  husband  of  the  Virgin 
Mary  may  have  ripened  into  a  dream,  of  intensity 
sufficient  to  guide  his  subsequent  action.  Nothing 
could  be  more  natural  for  one,  like  him,  ignorant  of 
physiology  and  of  second  causes  in  general,  than  the 
ascription  of  such  an  event  to  the  immediate  interven- 
tion of  the  Great  First  Cause — the  only  cause  which 
he  could  rationally  apprehend.  Hence  the  universal 
primitive  belief  that  in  dreams  God  spake  to  man. 
Upon  this  belief  was  laid  the  foundation  of  many  of 
the  religious  convictions  which  have  grown  and  ripened 
with  the  progress  of  the  race  until  their  shadowy  origin 
has  been  well  nigh  forgotten. 

Many  are  wont  to  affirm  that  the  age  of  illumina- 
tion through  the  intervention  of  dreams  is  past,  but 
there  is  no  good  reason  for  the  belief  that  such  dreams 
may  not  still  occur.  A  lady,  carefully  educated  in  the 
doctrines  of  the  popular  theology,  had  been  very  much 
distressed  by  the  unruly  behavior  of  her  only  child,  a 
little  imp  who  had  scarcely  learned  to  talk.  While 
thus  depressed  in  spirits  she  dreamed  that  the  Day  of 
Judgment  had  come.  She  found  herself  with  her  hus- 
band and  child  and  the  whole  human  race  assembled 
upon  the  face  of  the  earth,  waiting  in  agony  for  the 
awful  decision  of  their  fate.  Finally  the  heavens  were 
opened,  and  Jesus  appeared,  dividing  the  wicked  from 
the  good.  As  he  drew  near  the  place  where  she  was 
standing,  she  could  no  longer  endure  her  anxiety 
regarding  the  destiny  of  her  daughter;  she  rushed 
forward,  and  implored  the  Divine  Judge  to  spare  her 
child.    With  a  look  of  ineffable  compassion  he  assured 


REVELATION.  161 

the  trembling  suppliant  that  her  prayer  was  granted, 
and  she  awoke  in  a  state  of  great  agitation,  but  much 
comforted  as  to  the  future  of  her  little  girl,  who  in  due 
course  of  time  grew  up  to  be  a  very  exemplary  young 
woman.  Now,  if  the  dream  of  Joseph  was  a  revela- 
tion, a  dream  like  this  is  quite  as  worthy  of  similar 
estimation.  They  both  occurred  as  the  result  of  analo- 
gous conditions  of  the  brain  and  mind,  and  were  both 
excited  by  second  causes  of  a  similar  character.  It  is 
impossible  for  any  one  to  show  that  the  relation  be- 
tween the  First  Cause  and  either  set  of  second  causes 
was  any  more  intimate  and  special  in  one  case  than 
in  the  other. 

The  wonderful  exaltation  of  certain  faculties  during 
the  unequal  sleep  of  the  different  organs  of  the  mind, 
is  usually  to  be  considered  as  something  relative  rather 
than  absolute.  But  there  is  little  reason  to  doubt  that 
sometimes  the  excitement  of,  the  waking  portions  of 
the  brain  does  really  transcend  the  ordinary  functional 
capacity  of  the  structure.  Under  such  conditions  the 
undivided  concentration  of  attention  upon  the  compar- 
atively limited  circle  of  ideas  which  are  thus  produced, 
greatly  increases  the  intensity  of  the  resulting  impres- 
sions upon  the  mind  in  consciousness.  Hence  the 
grandeur  of  the  visions  which  may  thus  arise ;  hence, 
also,  the  possibility  of  their  construction  in  accordance 
with  fact  rather  than  with  fancy ;  as  in  the  case  of  the 
visions  of  the  ancient  Hebrew  prophets.  As  the  dark- 
ness of  night,  by  shutting  out  the  earth  from,  sight, 
opens  our  eyes  to  the  glory  of  the  starry  sky,  so,  in 
like  manner,  sleep,  by  closing  the  senses  against  the 

distractions  of    the    external    world,  may    sometimes 
11 


1B2  INSOMNIA. 

afford  the  conditions  enabling  a  richly  gifted  intellect 
to  comprehend  the  course  and  the  destination  of  those 
deep  and  silent  streams  of  thought  which  move  on, 
unnoticed  during  the  hours  of  wakeful  life. 

Whatever  may  be  true  of  this  matter  of  fore-sight, 
it  is  certain  that  under  similar  conditions  the  memory 
of  past  events  may  be  so  quickened  as  to  yield  results 
quite  comparable  with  actual  clairvoyance.  A  good 
illustration  of  this  has  been  recorded  by  Abercrombie. ' 
A  gentleman  named  Rowland  had  been  prosecuted  for 
certain  arrears  of  tithe  which  he  believed  had  been 
long  previously  paid  by  his  deceased  father.  "  But, 
after  an  industrious  search  among  his  father's  papers, 
an  investigation  of  the  public  records,  and  a  careful 
inquiry  among  all  persons  who  had  transacted  law 
business  for  his  father,  no  evidence  could  be  discov- 
ered to  support  his  defence.  The  period  was  now  near 
at  hand  when  he  conceived  the  loss  of  his  lawsuit  to  be 
inevitable,  and  he  had  formed  his  determination  to  ride 
to  Edinburgh  next  day  and  make  the  best  bargain  he 
could  in  the  way  of  compromise.  He  went  to  bed  with 
this  resolution,  and,  with  all  the  circumstances  of  the 
case  floating  upon  his  mind,  had  a  dream  to  the  follow- 
ing purpose:  His  father,  who  had  been  many  years 
dead,  appeared  to  him,  as  he  thought,  and  asked  him 
why  he  was  disturbed  in  his  mind.  In  dreams  men 
are  not  surprised  at  such  apparitions.  Mr.  R.  thought 
that  he  informed  his  father  of  the  cause  of  his  distress, 
adding  that  the  payment  of  a  considerable  sum  of 
money  was  the  more  unpleasant  to  him  because  he  had 
a  strong  consciousness  that  it  was  not  due,  though  he 

^Inquiries  concerning  the  Intellectual  Po7uers,  tenth  edition,  p.  283. 


REMINISCENCE.  163 

was  unable  to  recover  any  evidence  in  support  of  Ms 
belief.  '  You  are  right,  my  son,'  replied  the  paternal 
shade ;  '  I  did  acquire  right  to  these  teinds,  for  pay- 
ment of  which  you  are  now  prosecuted.  The  papers 
relating    to    the    transaction    are    in    the    hands    of 

Mr.  ,  a  writer  (or  attorney),  who  is  now  retired 

from  professional  business,  and  resides  at  Inveresk, 
near  Edinburgh.  He  was  a  person  whom  I  employed 
on  that  occasion  for  a  particular  reason,  but  who  never, 
on  any  other  occasion,  transacted  business  on  my 
account.     It  is  very  possible,'  pursued  the  vision,  '  that 

Mr. may  have  forgotten  a  matter  which  is  now  of 

a  very  old  date ;  but  you  may  call  it  to  his  recollection 
by  this  token  —  that  when  I  came  to  pay  his  account 
there  was  difficulty  in  getting  change  for  a  Portugal 
piece  of  gold,  and  that  we  were  forced  to  drink  out  the 
balance  at  a  tavern.' 

"  Mr.  R.  awoke  in  the  morning  with  all  the  events 
of  the  vision  impressed  on  his  mind,  and  thought  it 
worth  while  to  ride  across  the  country  to  Inveresk, 
instead  of  going  to  Edinburgh.  When  he  came  there 
he  waited  on  the  gentleman  mentioned  in  the  dream,  a 
very  old  man;  without  saying  anything  of  the  vision, 
he  inquired  whether  he  remembered  having  conducted 
such  a  matter  for  his  deceased  father.  The  old  gen- 
tleman could  not  at  first  bring  the  circumstance  to  his 
recollection,  but,  on  mention  of  the  Portugal  piece  of 
gold,  the  whole  returned  upon  his  memory;  he  made 
an  immediate  search  for  the  papers  and  recovered  them, 
so  that  Mr.  E.  carried  to  Edinburo^h  the  documents 
necessary  to  gain  the  cause  which  he  was  on  the  verge 
of  losing." 


164  INSOMTSri^. 

Here  it  would  be  a  valuable  addition  to  knowl- 
edge if  the  parties  in  the  history  just  related  could  be 
subjected  to  intelligent  interrogation.  Enough,  how- 
ever, may  be  discovered  in  the  narrative  to  render  it 
certain  that  the  dream  was  merely  a  revival  in  con- 
sciousness of  knowledge  that  had  been  long  previously 
forgotten.  There  was  a  vague  recollection  of  some 
such  information  evidently  struggling  for  recognition ; 
otherwise  Mr.  R.  could  not  have  held  the  belief  in  spite 
of  the  lack  of  evidence,  that  his  father  had  paid  the 
tithes  in  dispute.  He  had  probably  heard  from  his 
father  some  account  of  a  transaction  which  had  taken 
place  so  long  before  that  the  only  surviving  actor,  the 
aged  lawyer,  had  forgotten  everything  about  it,  and 
could  only  recall  the  event  through  the  associations  con- 
nected with  the  Portugal  piece  of  gold.  In  the  law- 
yer's case  the  cerebral  register  only  needed  the  stimu- 
lus afforded  by  the  association  of  ideas,  in  order  to 
make  it  again  place  before  the  mind  impressions  which 
had  long  subsided  below  the  ^level  of  consciousness. 
For  Mr.  R.,  sleep  afforded  the  limitation  of  cerebral  func- 
tion needful  for  a  concentration  of  attention  sufficient  to 
penetrate  to  the  level  of  the  residual  vibrations  which 
persisted  as  the  sole  representatives  of  the  original 
impressions  through  which  his  knowledge  of  the  event 
had  been  primitively  obtained.  Parallel  examples  are 
furnished  by  the  cases  of  individuals  who,  upon  their 
death-beds,  during  the  dissolution  of  the  brain,  have 
resumed  a  long  disused  vocabulary,  speaking  the 
language  and  thinking  the  thoughts  of  their  childhood. 
"  He  'babbled of  green  fields,'  "  said  Mistress  Quickly, 
narrating  the  closing  scenes  in  the  life  of  the  famous 


REMINISCENCE.  165 

Sir  John  Falstaff.  Dr.  Kush'  relates  the  case  of  a 
learned  Italian  gentleman  who,  "  in  the  beginning  of 
the  yellow  fever  which  terminated  his  life, 
spoke  English  only;  in  the  middle  of  the  disease,  he 
spoke  French  only;  but  on  the  day  of  his  death,  he 
spoke  only  in  the  language  of  his  native  country."  In 
like  manner  the  old  Swedish  settlers  in  Philadelphia 
who  had  forgotten  their  native  language,  or,  at  least, 
had  not  spoken  it  for  half  a  century,  would  pray  in 
Swedish  on  their  death -beds.  ^  Sleep  and  dissolution 
operate  alike  to  release  the  lower  levels  of  the  mne- 
monic apparatus  from  the  overshadowing  influence  of 
later  impressions,  so  that,  like  an  ancient  palimpsest, 
it  presents  once  more  its  long-forgotten  characters 
for  inspection  by  the  mind. 

^  Medical  Inquiries  and  Observations   upon  Diseases  of  the  Mind, 
p.  277. 

'  Loc.  cit. 


CHAPTER   VI. 

SOMNAMBULISM. 

A  great  perturbation  in  nature  !  to  receive  at  once  the  benefit  of  sleep,  and  do 
the  effects  of  watching.  — Macbeth. 

We  have  seen  that  in  certain  cases  dreams  manifest 
a  tendency  to  pass  into  action.  Thus,  the  dream  with 
which  I  was  on  one  occasion  occupied  became  so  amus- 
ing that  I  was  awakened  by  a  paroxysm  of  laughter 
that  continued  for  some  time  after  the  termination  of 
the  dream.  Sometimes  the  actions  which  are  thus 
determined  become  more  complicated,  but  do  not  suffice 
to  arouse  the  sleeper.  He  continues  to  dream,  and  to 
act  out  his  dream.  This  constitutes  the  ordinary  form 
of  somnambulism.  It  is  a  special  affection  of  the  nerv- 
ous system  encountered  chiefly  among  persons  of  a 
decidedly  neurotic  constitution — especially  among  the 
victims  of  hysteria,  epilepsy,  and  insanity.  Sometimes 
occurring  in  cases  apparently  characterized  by  perfect 
health,  it  will  usually  be  discovered  by  careful  inquiry 
that  the  subject  is  nevertheless  connected  by  near  rela- 
tionship with  a  neurotic  stock.  In  a  third  class  of 
patients  the  neuropathic  diathesis  is  not  congenital,  but 
is  the  acquired  result  of  particular  injuries  or  diseases 
of  the  head.  It  is  also  observed  sometimes  as  a  conse- 
quence of  transitory  functional  disturbances  of  the 
brain  connected  with  the  period  of  convalescence  from 

(166) 


SOMNAMBULISM.  '  1B7 

diseases  that  profoundly  affect  the  nutrition  of  the 
nervous  system.  In  all  cases,  however,  it  is  probable 
that  a  special  nervous  temperament  exists  as  a  predis- 
posing cause  of  the  phenomena,  for  the  majority  of 
people  can  sustain  injuries  of  the  head,  or  of  the  peri- 
pheral nervous  system,  and  can  pass  through  all  kinds 
of  illness  without  exhibiting  any  tendency  to  somnam- 
bulism. As  the  nervous  temperament  is  the  peculiar 
property  of  children  and  of  the  female  sex,  it  is  among 
them  that  the  affection  is  usually  observed.  Before 
the  age  of  puberty,  however,  the  differential  peculiari- 
ties of  sex  are  not  sufficient  to  produce  any  great  pre- 
ponderance in  either  direction;  and  small  boys  are, 
therefore,  perhaps  as  frequently  somnambulistic  as 
their  little  sisters.  Like  other  neuropathic  disorders, 
this  predisposition  is  frequently  met  with  as  an  hered- 
itary attribute  which  may  be  handed  down  from  gen- 
eration to  generation.  Occurring  in  the  experience  of 
young  children,  it  frequently  ceases  when  they  arrive 
at  years  of  maturity.  Not  always,  however,  thus  ceas- 
ing as  a  consequence  of  improvement  in  the  general 
health,  but  because  of  the  substitution  of  some  more 
serious  disorder. 

The  phenomena  of  ordinary  somnambulism  are 
manifested,  like  the  dreams  out  of  which  they  arise, 
during  the  period  of  sleep.  But,  while  dreams  most 
frequently  occur  during  the  later  portion  of  the  night, 
after  the  deepest  sleep  is  past,  somnambulism  usually 
occurs  in  the  earlier  part  of  the  night,  during  the  deep- 
est sleep.  As  a  consequence  of  this  fact,  conscious- 
ness is  seldoni  affected  by  the  molecular  play  of  the 
brain  during  the  somnambulic  excursion.     The  sleep- 


168  •  INSOMNIA. 

walker  knows  nothing,  and  remembers  nothing  of  the 
incidents  in  which  he  has  been  an  active  agent;  while 
the  dreamer  seems  to  be  more  nearly  awake.  His 
consciousness  is  partially  aroused  by  the  play  of 
memory  and  of  imagination,  and  he  can  remember  the 
spectacle  which  constituted  his  dream.  The  phe- 
nomena of  somnambulism  necessitate  the  participation 
of  a  larger  number  of  faculties  than  are  needed  for 
the  production  of  a  dream,  but  their  activities  are 
coordinated  upon  a  plane,  so  to  speak,  lower  than  the 
platform  upon  which  the  elements  of  dreams  are 
arranged.  Consequently,  though  the  elements  of  the 
somnambulic  process  may  be  far  more  numerous  and 
various  than  the  elements  of  a  dream,  they  may  be  less 
capable  of  rising  into  the  realm  of  consciousness.  Such 
a  process  may  differ  from  the  phenomena  of  ordinary 
life  only  in  the  fact  of  unconsciousness ;  and,  when  con- 
cluded, it  leaves  no  traces  in  the  memory  of  the  waking 
state.  In  other  instances,  on  the  contrary,  so  many 
nervous  functions  may  be  suppressed,  and  so  great 
may  be  the  intensity  of  the  remaining  cerebral  pro- 
cesses, that  the  resulting  phenomena  scarcely  differ 
from  an  ordinary  dream  in  which  consciousness  is 
aroused,  and  the  waking  memory  is  durably  impressed. 
Between  these  extremes  lie  opportunities  for  an  indefi- 
nite number  of  combinations ;  consequently  the  forms 
and  degrees  of  somnambulism  present  a  very  great 
variety  of  manifestation.  Maury  '  reduces  these  to  five 
principal  forms :  First,  simple  movement  of  the  limbs 
in  connection  with  that  partial  sleep  of  the  intellectual 
faculties  which  produces  ordinary  dreams.     Second, 

'  Le  Sommeil  et  ies  Reves,  p.  248. 


SOMNAMBULISM.  169 

somjiiation,  a  state  in  which  the  patient  unconsciously 
performs  such  actions  as  have  become  so  far  habitual 
that,  though  complicated  in  their  character,  they  con- 
stitute genuine  cerebral  reflexes.  Third,  noctamhitlism, 
or  sleep-walking,  in  which  the  action,  though  compli- 
cated in  its  character,  and  different  from  the  ordinary 
waking  occupations  of  the  patient,  appears  to  be  the 
result  of  automatic  processes,  constituting  a  dream  that 
is  acted  out  in  time  and  space.  Fourth,  somnambulism 
with  exaltation  of  the  faculties,  producing  delirium 
with  conscious  movements  during  the  crisis.  Fifth, 
somnambulic  life,  or  double  consciousness,  in  which, 
with  the  exception  of  certain  special  modifications  of 
intelligence,  the  conduct  of  the  patient  during  the 
paroxysm  does  not  perceptibly  differ  from  that  of  the 
waking  state,  so  that  the  subject  seems  to  experience 
two  successive  though  disconnected  personalities. 

The  exact  relation  between  these  different  degrees 
of  somnambulism  has  been  further  elucidated  by  MM. 
Ball  and  Chambard.^  Starting  with  the  proposition 
that  normal  healthy  existence  is  a  state  in  which  the 
functions  of  organic  life  furnish  a  basis  for  nervous 
sensibility  and  motion,  by  means  of  which  the  imagina- 
tive faculties  (imagination  and  memory),  associated 
with  the  coordinative  faculties  (attention,  judgment, 
volition),  are  sufficiently  stimulated  to  maintain  a  state 
of  consciousness,  they  show  that  the  first  stage  of  sleep 
consists  in  the  suppression  of  bodily  motion  and  sensi- 
bility. The  second  stage  consists  in  the  further  sup- 
pression of  the  coordinative  faculties.  The  third  stage 
is  marked  by  the  loss  of  memory  and  imagination.     In 

^  Die.  Encyc.  des  Sci.  M^d.,  Article  Somnambulisme  Xaturel. 


170  INSOMNIA. 

the  most  profound  and  perfect  sleep  the  functions  of 
organic  life  alone  remain.  The  process  of  awaking 
consists  in  the  revival  of  the  faculties  in  the  inverse 
order  of  their  extinction.  Dreams  occur  during  the 
period  in  which  motion,  sensation,  and  the  coordinative 
faculties  are  in  abeyance;  but  somnambulism  may 
accompany  each  of  the  stages  of  sleep.  Its  simplest 
form  is  perhaps  the  rarest;  corresponding  to  Maury's 
fifth  variety.  In  this  form  the  functions  of  organic 
life  are  intact ;  motion  and  sensibility  seem  unchanged ; 
the  intellectual  faculties  display  their  usual  activity; 
but  the  ordinary  consciousness  is  never  aroused.  So 
far  as  the  normal  life  of  the  subject  is  concerned,  he  is 
active,  sensible,  intelligent,  but  unconscious ;  and  when 
the  paroxysm  is  terminated  memory  contains  no 
account  of  its  events.  Such  paroxysms  may  occur  but 
once  in  the  life-time  of  an  individual,  or  they  may  be 
repeated  at  stated  intervals,  constituting  an  alternate 
succession  of  mental  states  without  connection  in  con- 
sciousness. This  is  called  the  somnambulic  life,  or 
double  consciousness,  several  examples  of  which  will 
be  related  upon  another  page. 

The  second  form  of  somnambulism  results  from  the 
abolition  of  consciousness  and  the  more  or  less  com- 
plete suppression  of  the  coordinative  faculties  of  the 
mind.  Memory  and  imagination,  released  in  great 
measure  from  the  control  of  the  higher  intellectual 
faculties,  and  excited  by  such  vestiges  of  sensation  as 
still  persist,  create  a  species  of  delirium  in  which 
mutilated  sensations,  half  formed  thoughts  and  dispro- 
portioned  volitions  combine   to  produce  a  variety  of 


SOMNAMBULISM.  171 

actions.  In  this  condition  the  patient  dreams,  and  acts 
out  his  dream.      He  is  a  somnambulic  dreamer. 

In  the  third  degree  of  somnambulism,  conscious- 
ness and  the  entire  range  of  intellectual  faculties  have 
disappeared.  The  individual  resembles  a  creature 
from  which  the  cerebral  hemispheres  have  been 
removed.  He  is  little  better  than  a  living  automaton, 
guided  only  by  impressions  received  from  without.  In 
this  condition  the  movements  of  the  body  may  become 
wholly  responsive  to  the  will  of  another- — a  prominent 
characteristic  of  artificial  somnambulism  or  hypno- 
tism. 

A  fourth  degree  of  somnambulism  is  marked  by  the 
disappearance  of  consciousness,  intellect,  sensibility, 
and  the  power  of  motion.  Only  the  lower  functions  of 
organic  life  remain.  The  patient  merely  lives,  he 
neither  thinks  nor  acts.  This  constitutes  the  state  of 
somnambulic  lethargy,  a  condition  which  differs  from 
deep  sleep  only  in  the  fact  that  under  the  influence  of 
external  impulses  or  of  partial  awaking  it  may  easily 
pass  into  the  second  form  of  the  affection,  the  som- 
nambulic dream. 

Such  is  the  classification  of  MM.  Ball  and'  Cham- 
bard.  It  possesses  the  merit  of  great  precision  and 
clearness.  If  the  warning  which  its  authors  them- 
selves utter  against  its  too  literal  acceptance  be 
respected,  it  will  be  found  to  afford  a  very  convenient 
explanation  of  the  manner  in  which  the  various  degrees 
of  somnambulism  are  reached.  But  it  must  be  remem- 
bered that  between  these  pronounced  and  definite  forms 
exist  a  great  number  of  intermediate  degrees.  Partial 
revivals  and  temporary   resurrections   of    the   higher 


172 


INSOMNIA. 


faculties  of  the  mind  may  intrude  themselves  among 
the  activities  which  depend  upon  lower  functions ;  as, 
for  example,  when  the  ordinary  unconsciousness  of 
lethargy  is  briefly  interrupted  by  an  event  which  may 
remain  permanently  fixed  in  memory  after  waking,  even 
though  all  other  concurrent  incidents  were  unnoticed 
and  left  no  trace  behind.  Keeping  this  caution  in 
mind,  the  following  diagram  will  be  found  useful : 


<t-i 
13 
o 

a 
<a 
bo 

o 

.t:  a 

11 

Coordinative  Faculties: 

Attention,  Judgment, 

Volition. 

EC 

oo 
V 

a 

Oi 

a 
o 
o 

00 

a 
o 
O 

1         1        1 

1         1        1 

Somnambulic  life 

1         1        1 

1         1 

^^^ 

Somnambulic  dream 

1         1 

1 

Somnambulic  automatism 

1 

^^^m(nn 

1 

Somnambulic  lethargy 

- 

The  close  parallel  between  this  diagram  and  the 
the  one  on  page  4,  which  illustrates  the  course  of 
sleep,  will  be  at  once  remarked.  The  difference  between 
the  two  states  cannot  be  thus  diagrammatically 
expressed.  It  is  the  difference  between  sleep  in  a 
healthy,  normal  subject,  and  sleep  as  modified  by  the 
somnambulistic  temperament.  This  may  be  either  the 
result  of  disease  or  of  congenital  defect  of  cerebral 
organization.      What  the  particular  structural  differ- 


SOMNAMBULIC   LETHARGY.  173 

ence  may  be,  it  must  be  impossible  to  decide,  until  it 
shall  become  possible  to  state  the  reason  why  one 
brain  shall  behave  only  in  a  normal  manner,  while 
another  presents  all  the  vagaries  of  hysteria,  som- 
nambulism, —  perhaps  even  of  insanity.  That  the 
affection  is  hereditary  is  a  matter  of  common  observa- 
tion. One  of  my  patients  who  is  somnambulistic  — 
walking  in  his  sleep,  climbing  over  the  roof  of  his 
house,  etc. — is  the  son  of  a  father  who  was  also  a  noc- 
tambulist,  and  who  once  fractured  his  leg  by  falling 
from  a  step  as  he  was  walking  down  stairs  in  his  sleep. 
A  grand-daughter  is  both  a  somniloquist  and  a  som- 
nambulist. 

Eeturning  now  to  the  classification  adopted  by  Ball 
and  Ohambard,  it  will  be  found  interesting  to  consider 
a  f-ew  illustrative  examples  of  the  different  forms  and 
degrees  of  the  affection  under  consideration. 

Somnambulic  Lethargy. — This  condition  represents 
the  form  which  outwardly  resembles  profound  sleep. 
It  may  occur  as  a  paroxysm  without  relation  to 
other  forms  of  the  affection,  or,  according  to  my  own 
observation,  more  frequently  associated  with  other 
forms  of  somnambulism.  Thus,  one  of  my  patients,  a 
lady  about  thirty-five  years  of  age,  having  accident- 
ally fallen  into  the  hands  of  a  noted  empiric,  by  whom, 
for  a  slight  attack  of  tonsillitis,  she  was  vigorously 
dosed  with  atropia,  digitalis  and  calabar  bean,  finally 
passed  into  a  somnambulic  state  corresponding  to  the 
somnambulic  life  of  the  preceding  table.  This  con- 
tinued about  five  weeks,  when  she  became  completely 
lethargic,  and  was  transferred  to  my  care.  In  this 
condition  she  remained  unconscious,  almost  perfectly 


1<^  INSOMNIA. 

insensible,  with  pupils  somewhat  contracted  and  slug- 
gish before  the  light,  with  a  feeble  and  slightly  accel- 
erated pulse,  a  moderately  elevated  temperature,  bowels 
and  bladder  insensible  to  their  contents,  mouth  and 
throat  filled  with  an  offensive  mucous  secretion.  By 
great  urgency  she  could  be  sufficiently  roused  to  open 
her  mouth,  so  as  to  permit  cleansing  the  cavity,  and  to 
swallow  liquid  food.  Swallowing  was  effected  very 
slowly,  and  only  after  the  liquid  had  remained  for 
some  time  in  the  fauces.  At  the  end  of  about  three 
weeks  the  patient  began  to  exhibit  more  vitality.  She 
could  be  more  easily  aroused,  began  to  dream  and  to 
have  hallucinations  that  were  finally  prolonged  out  of 
sleep  into  wakefulness.  In  the  course  of  a  few  hours 
she  was  fully  herself  again,  after  eight  weeks  of 
unconsciousness. 

This  form  of  lethargy  is  characterized  by  the  com- 
plete unconsciousness  which  persists  during  its  course. 
Its  duration  is  variable,  sometimes  continuing  for  a 
few  minutes  only;  sometimes  lasting  through  many 
days  and  weeks.  Dr.  W.  T.  Gairdner,  Professor  of 
Medicine  in  the  University  of  Glasgow,'  reports  the 
case  of  a  woman  who  remained  for  over  one  hundred 
and  sixty  days  in  a  condition  of  lethargic  stupor.  "  The 
patient  was  the  mother  of  a  family,  and  had  lived  a 
strictly  domestic  and  (up  to  a  short  time  before  her 
seizure)  healthy  and  regular  life.  There  were  no 
peculiar  moral  and  religious  problems  to  perplex  the 
situation.  There  was  no  history  of  inveterate  hysteria, 
or  of  long  continued  rapt  contemplation ;  nor  has  there 
been  the  slightest  evidence  of  any  craving  after  noto- 

"^  The  Lancet,   Dec.  22,  1883,  p.  1,078,  and  Jan.  5,  1884,  p  5. 


SOMNAMBULIC   LETFIARGY.  175 

riety,  either  before  the  attack  or  since  its  termination. 
The  moral  atmosphere,  in  short,  surrounding  the  phe- 
nomena, is  altogether  unfavorable  to  exaggeration  and 
imposture,  for  which,  indeed,  no  reasonable  motive  can 
be  assigned.  Nevertheless,  under  these  very  common  - 
place  conditions,  concurring  with  some  degree  of 
melancholy  or  mental  despondency  after  delivery, 
but  during  a  convalescence  otherwise  normal,  Mrs. 
McI presents  to  our  notice  a  condition  of  sus- 
pended consciousness  and  disordered  innervation  in  no 
degree  less  extreme  than  the  '  trances '  or  cataleptic 
attacks  which  have  been  recorded  as  the  result  of  the 
most  aggravated  hysteria,  or  as  the  miracles  of  relig- 
ious ecstasy  and  profound  mental  emotion.  She  be- 
comes for  th^  long  period  of  over  one  hundred  and  sixty 
days  continuously  an  almost  mindless  automaton,  con- 
nected with  the  external  world  only  through  a  few 
insignificant  reflexes  and  through  the  organic  func- 
tions. She  is  fed,  almost  without  resistance,  through 
the  stomach -tube ;  she  defecates  and  urinates  (during 
much  the  greater  part  of  the  time)  unconsciously ;  she  is 
absolutely  passive  as  regards  everything  that  demands 
spontaneous  movement,  and  betrays  almost  no  sign  of 
sensation,  general  or  special,  when  subjected  to  the 
severest  tests  that  can  be  applied  short  of  physical 
injury.  But  while  her  senses  were  thus  shut,  and  her 
volitions  in  suspense  to  an  extent  much  beyond 
ordinary  sleep,  there  was,  nevertheless,  a  sleep  within 
the  sleep.  The  periodicity  of  day  and  night  was 
maintained  by  some  change  in  the  condition  of  the 
innervation,  of  which  snoring  was  the  sole  indication. 
She  was  not  convulsed,  nor  paralyzed,  nor  delirious; 


176  INSOMNIA. 

the  singing,  laughing,  weeping,  adoring  ecstasies  of 
hysteria  and  of  religious  excitement  were  wholly  want- 
ing; nor  Avere  there  during  many  months  such  inter- 
vals of  normal  consciousness  as  are  observed  in  almost 
all  the  recorded  cases  of  hysterical  coma  and  of  cata- 
lepsy. The  statue-like  pose,  moreover,  and  the  flexi- 
hilitas  cerea  of  typical  catalepsy,  are  absent  in  this 
case.  The  return  to  consciousness  was  followed  or 
accompanied  by  a  return  of  all  the  normal  functions  of 
mind  and  body  j  there  is  now  no  incoherence,  nor  even 
distorted  perceptions,  as  of  a  dream-life  occupying  the 
somnolent  imagination  for  months,  and  therefore  all 
the  more  hard  to  reconcile  with  realities.  She  is  self- 
possessed,  but  unobtrusive,  easily  managed,  and  betray- 
ing only  natural  emotion;  she  persists  in  maintaining 
that  the  whole  period  of  the  apparent  unconsciousness 
is  a  complete  blank  to  her  recollection.  She  is  grate- 
ful for  her  recovery,  but  manifests  no  craving  for  sym- 
pathy, and  no  tendency,  as  yet,  to  revert  to  any  morbid 
condition  of  despondency,  such  as  was  described  at  the 
commencement  of  the  attack.  In  connection  with  this 
last  point,  although  there  is  no  evidence  of  her  having 
been  personally  insane,  it  is  not  to  be  denied  that  her 
family  history  contains  strong  presumptions  of  a  hered- 
itary predisposition  bearing  in  that  direction." 

These  cases  must  not  be  confounded  with  the 
examples  of  lucid  lethargy,  to  which  allusion  has  been 
made  in  a  previous  chapter.  Somnambulic  lethargy 
is  a  condition  in  which  the  cerebrum  is  wholly  inert. 
In  lucid  lethargy,  although  there  is  complete  loss  of 
general  sensibility  and  of  the  power  of  voluntary 
motion,    the    field    of    consciousness    is    continually 


SOMNAMBULISM.  177 

enlightened  by  perceptions  derived  from  one  or  more 
of  the  special  senses,  so  that  the  subject  is  conscious 
of  much  that  transpires  in  his  immediate  neighbor- 
hood. These  two  forms  of  lethargy  sometimes  alter- 
nate in  the  experience  of  the  same  individual,  consti- 
tuting a  portion  of  the  indefinitely  varied  manifestations 
of  hystero-epilepsy.  Grasset  relates  the  case^  of  a  little 
girl,  ten  years  old,  who  suffered  Avith  various  forms  of 
hysteria,  which  were  finally  replaced  by  attacks  of 
stupor,  lasting  several  hours.  After  a  time  these  crises 
of  "  nervous  sleep  "  were  transformed  into  more  ordin- 
ary attacks  of  somnambulism,  in  which,  "  although  the 
child's  eyes  are  shut,  she  sees  and  hears  everything 
during  the  crises,  knows  who  comes  into  the  room  by 
their  step  and  walk.  If  anything  unpleasant  is  said  to 
her,  or  if  they  threaten  to  wet  her,  or  make  her  smell 
something,  she  gets  angry,  and  pushes  everything 
violently  away  that  is  offered  to  her.  She  replies  by 
signs  to  all  questions,  and  if  she  wants  anything, 
asks  for  it  by  gesture:  if  she  wants  to  drink,  she 
puts  her  finger  to  her  lips  as  if  in  the  act  of  suck- 
ing, and  if  not  understood,  becomes  irritated,  gets  up, 
and  leads  the  father  or  mother  to  the  sideboard  or 
cupboard,  where  the  things  she  wants  are,  and  always 
with  the  eyes  shut.  She  is  able  to  go  through  the 
whole  house,  I  do  not  say  quite  alone,  because  they  do 
not  allow  her  to  walk  alone,  but  with  help,  and  she 
directs  the  way  wherever  she  wishes  to  go.  During 
the  crises  she  even  sometimes  amuses  herself  with  a 
little  dog,  which  she  makes  jump  over  a  stick  resting 
on  the   cross-bars   of   two  chairs   opposite  each  other; 

^Brain,  Jan.,  1884,  p.  454. 
12 


178  INSOMNIA. 

and  according  as  she  wishes  the  dog  to  jump  higher  or 
lower,  she  moves  the  stick  to  the  lower  or  higher  bars 
of  the  chairs,  and  that  with  eyes  always  shut  spasmod- 
ically. During  the  whole  attack  she  cannot  talk;  but 
towards  the  end  she  speaks,  although  not  yet  recovered 
from  her  state  of  somnambulism.  When  the  crisis  is 
over,  the  child  remembers  nothing  of  what  she  has  said 
or  done  in  her  sleep,  and  is  much  surprised  at  every- 
thing told  her," 

Somnambulic  Dreams.  —  The  preceding  cases  illus- 
trate the  variable  character  of  the  manifestations  of 
somnambulism,  and  may  also  serve  as  an  introduction 
to  the  more  common  form  of  the  affection,  in  which  the 
patient  experiences  a  dream,  probably  excited  by  the 
same  causes  that  produce  ordinary  dreams,  and  also 
acts  out  his  dream.  The  differences  between  an 
ordinary  dream  and  a  somnambulic  dream  lie  in  the 
fact  that  the  one  produces  an  often  vivid  impression 
upon  consciousness  and  memory,  while  the  other  is 
entirely  expended  upon  the  organs  of  external  expres- 
sion. Starting  probably  from  the  same  portion  of  the 
brain,  the  physiological  dream  sets  in  motion  the  cor- 
tical structures  which  are  in  immediate  relation  with 
conscious  memory;  the  impulses  of  the  somnambulic 
dream,  on  the  contrary,  are  directed  towards  the  lower 
portions  of  the  nervous  system,  where  they  serve  to 
excite  the  organs  of  locomotion  and  expression,  which 
are  destitute  of  every  form  of  mnemonic  register.  Con- 
sequently, the  somnambulist  retains  no  recollection  of 
the  incidents  of  his  dream. 

The  simplest  form  of  this  atfection  is  presented  by 
the  restless  child  who  talks,  cries  out,  and  brandishes 


NIGHT   TERRORS.  179 

its  fists  in  sleep.  In  the  majority  of  instances  these 
manifestations  create  little  more  disturbance  than  the 
half  uttered  yelping  of  a  dog  that  barks  in  its  sleep. 
But  in  some  cases  the  outbreak  assumes  a  distressing, 
if  not  an  alarming  character,  constituting  the  affection 
known  by  the  name  of  night  terrors.  The  disorder  is 
usually  observed  in  young  children  of  a  highly  nerv- 
ous temperament,  before  the  conclusion  of  their  second 
dentition.  The  little  patients  are  generally  of  neurotic 
lineage.  Insanity,  hysteria,  neurasthenia,  epilepsy, 
chorea,  and  nervous  dyspepsia,  are  often  discovered 
among  their  near  relatives.  Not  unfrequently  they 
have  been,  or  will  become,  choreic.  The  attack  is 
often  preceded  by  symptoms  of  indigestion  and  con- 
stipation ;  but  the  exciting  cause  may  be  usually  traced 
in  the  commotion  of  a  brain  that  has  been  wearied  by 
the  exertions  of  the  previous  day.  The  child  starts  up 
out  of  an  apparently  sound  sleep,  crying  with  seeming 
alarm,  calling  for  his  mother,  and  staring  wildly 
around,  with  every  possible  expression  of  terror.  Some- 
times .he  jumps  from  his  couch,  and  runs  headlong  into 
a  corner,  or  seeks  concealment  under  the  bed,  as  if 
escaping  from  some  frightful  object.  The  eyes  are 
open,  tears  flow,  perspiration  covers  the  skin,  there  is 
the  greatest  excitement,  and  the  little  one,  clinging 
convulsively  to  its  parent,  will  not  be  quieted.  Only 
after  a  number  of  minutes  does  the  child  seem  to 
recover  the  power  of  recognizing  his  friends.  Presently, 
however,  he  lies  down,  and  falls  immediately  asleep, 
waking  in  the  morning  without  the  slightest  remem- 
brance of  the  unpleasant  event. 

Such  paroxysms  occur  during  the  early  part  of  the 


180  INSOMNIA. 

night,  one  or  two  hours  after  bedtime,  when  sleep  is 
passing  from  its  maximum  intensity  to  an  inferior 
degree  of  depth.  This,  moreover,  is  the  time  when 
the  controlling  power  of  the  sensory  apparatus  over 
other  portions  of  the  nervous  system  has  already 
reached  its  minimum.  The  spinal  centres  and  those 
intra-cranial  ganglia  which  do  not  share  in  the  full 
measure  of  this  repose  are  therefore  in  a  condition  of 
relative  exaltation.  Disturbances  of  internal  origin, 
consequently,  produce  inordinate  excitement  of  these 
waking  portions  of  the  nervous  apparatus.  The 
abnormal  quality  of  this  excitement  is  attested  both 
by  the  history  of  the  patient,  and  by  the  fact  that  it 
does  not  pervade  the  whole  brain.  The  distribution  of 
motion  through  the  cerebrum  is  hindered,  so  that  cer- 
tain portions  of  the  organ  remain  asleep  while  other 
regions  are  thrown  into  a  state  of  tumultuous  uproar. 
Such  disconnection  of  the  different  organs  of  the 
nervous  system,  by  withdrawing  particular  ganglia 
from  the  inhibitory  influence  of  the  other  centres, 
gives  opportunity  for  violent  explosions  of  nervous 
force. 

Somewhat  similar  in  their  origin  are  those  acts  of 
unconscious  violence  which  sometimes  occur  during 
the  process  of  sudden  awakening  out  of  sound  sleep. 
The  patient  is  usually  a  deep  but  uneasy  sleeper,  who 
is  only  aroused  imperfectly  and  with  difficulty  when 
the  attempt  to  awaken  him  is  made.  Under  such 
circumstances  the  disturbance  to  which  he  is  subjected 
serves  as  the  exciting  cause  of  a  dream  which,  like  the 
ordinary  somnambulist,  he  puts  into  action  before  he 
is  fully  waked.     On  recovering  complete  consciousness, 


SLEEP  -  DRUNKENNESS.  181 

he  may  retain  no  recollection  of  the  events  of  his 
dream,  and  may  also  experience  as  great  a  degree  of 
astonishment  at  the  results  of  his  violence  as  if  he  had 
taken  no  part  in  its  display.  A  gentleman  of  my 
acquaintance,  who  had  suffered  considerable  uneasi- 
ness regarding  burglars,  was,  one  night,  startled  by  a 
noise  in  his  room.  Jumping  up  suddenly,  he  grasped 
a  pistol  and  fired  it  in  the  direction  of  a  figure  dimly 
perceived  near  the  bed.  On  waking  fully  out  of  sleep, 
he  found  that  he  had  inflicted  a  wound  upon  the  hand 
of  his  wife  whose  movements  had  disturbed  him. 
Another  unfortunate,  who  was  once  under  my  observa- 
tion for  undoubted  insanity,  was  in  like  manner  aroused 
out  of  sleep  by  a  supposed  noise,  probably  heard  in  a 
dream.  With  a  pistol  in  each  hand,  he  commenced 
firing  wildly  in  every  direction,  fatally  wounding  his 
wife  who  was  in  bed  at  his  side.  When  completely 
awakened  he  had  no  recollection  of  what  had  occurred, 
and  was  overwhelmed  by  the  event. 

Wharton  and  Stille  ^  have  collected  a  number  of 
similar  examples  of  this  disorder,  to  which  the  term 
somnolentia  or  sleep-drunkenness  has  been  applied.  Its 
connection  with  morbid  disturbance  of  the  brain  is 
usually  very  evident.  Obviously,  the  moral  responsi- 
bility of  the  agent  in  such  cases  is  identical  with  that 
of  the  ordinary  somnambulist,  or  of  the  subject  of 
epileptic  mania. 

Ordinarily,  however,  the  somnambulic  dream  is  less 
agitated.  The  patient  merely  continues  the  move- 
ments with  which  he  was  occupied  at  the  moment  of 
falling  asleep,  as   in  the  case  of  Galen,  who,  though 

^-  Medical  Jurisprudence,  3d  ed.,  Vol.  I,  pp.  464-471. 


182  INSOMNIA. 

long  an  unbeliever  of  the  tales  regarding  sleepy 
soldiers  who  had  unconsciously  continued  to  march 
with  their  comrades,  at  last  found  himself  in  a  similar 
manner  walking  a  considerable  distance  after  he  had 
been  overtaken  by  sleep  while  journeying  on  foot.  In 
other  cases  the  phenomena  though  intimately  con- 
nected with  the  daily  occupations  of  the  subject, 
present  themselves  in  a  form  somewhat  detached  from 
the  waking  life.  Such  are  the  common  experiences  of 
children  who  get  out  of  bed,  and  walk  around  the 
house,  seeking  their  playthings,  or  pulling  their  clothes 
out  of  the  drawers  in  which  they  have  been  laid.  Some- 
times the  events  of  the  day  have  evidently  suggested 
the  deeds  of  the  night.  One  of  my  little  acquaint- 
ances will  leave  her  bed,  walk  into  another  room,  seat 
herself  by  her  mother's  work-basket,  thread  a  needle, 
and  proceed  to  sew  up  the  imaginary  holes  in  her  dress. 
One  of  my  early  playmates,  in  like  manner,  after  puz- 
zling over  a  difficult  sum  in  arithmetic,  before  retiring, 
arose  in  his  sleep,  took  paper  and  a  pencil  from  his 
mother's  desk,  and  proceeded  before  her  eyes  to  work 
out  the  correct  answer.  Another,  tempted  probably 
by  a  vision  of  ripe  grapes  upon  the  trellis,  climbed  out 
of  his  window  upon  the  roof  of  a  shed.  Unfortunately, 
the  certainty  with  which  somnambulists  usually  direct 
their  movements  seemed  to  fail  him.  He  fell  heavily 
to  the  ground,  where  he  awoke  to  find  himself  seriously 
injured. 

An  excellent  example  of  a  still  more  complicated 
series  of  actions  during  somnambulism  is  quoted  by  P. 
Max   Simon.'     It   illustrates   a   majority   of   the  facts 

^  Le  Monde  lies  Reves,  p.  257. 


SOMNAMBULISM.  183 

which  have  been  already  brought  forward,  and  will 
well  reward  careful  consideration.  ''  A  young  clergy- 
man was  in  the  habit  of  getting  up  in  his  sleep,  taking 
paper,  composing  and  writing  sermons.  When  he  had 
finished  a  page,  he  would  read  it  over,  if  an  action 
performed  without  the  assistance  of  sight  can  be  called 
reading.  If  dissatisfied  with  anything,  he  would  blot 
it  out,  and  then  write  the  corrections  with  great  accu- 
racy in  their  appropriate  place  above  the  line.  In  one 
of  these  sermons  he  made  a  correction  which  was  quite 
remarkable.  Having  in  one  place  written  the  words 
ce  divin  enfant^  on  revising  the  page  he  decided  to 
substitute  the  word  adorable  instead  of  the  word  divin. 
He  therefore  blotted  out  this  last  word  and  placed  the 
other  immediately  over  it;  then,  perceiving  the  word 
ce,  which  was  proper  enough  before  the  word  divin, 
lacked  the  terminal  letter  t  that  was  needed  before  a 
vowel,  he  very  adroitly  added  the  necessary  letter,  so 
that  the  amended  sentence  correctly  read  cet  adorable 
enfant.  In  order  to  ascertain  whether  the  somnam- 
bulist made  any  use  of  his  eyes,  a  cardboard  was  placed 
under  his  chin  in  such  a  way  as  to  completely  obstruct 
the  view  of  the  paper  upon  the  table ;  but  he  continued 
to  write  without  paying  any  attention  to  the  obstacle. 
In  order  to  ascertain  whether  he  was  aware  of  the 
presence  of  the  objects  which  were  before  his  eyes,  the 
paper  upon  which  he  was  writing  was  taken  away,  and 
a  number  of  other  sheets  were  successively  slipped  into 
its  place;  but  he  always  noticed  the  substitution, 
because  they  differed  in  size.  When  an  exactly  simi- 
lar piece  was  substituted,  he  accepted  it  as  his  own, 
and  wrote   down  the  corrections   at  the  points  which 


184  INSOMNIA. 

corresponded  exactly  with  the  writing  upon  the  page 
which  had  been  removed.  It  was  by  means  of  this 
ingenious  stratagem  that  some  of  his  nocturnal  com- 
positions were  preserved. 

"  The  most  astonishing  thing  of  all,"  continues  the 
author  of  this  article,  "was  the  exact  composition  of 
music.  A  cane  served  him  as  a  ruler.  With  it  he 
ruled  at  equal  distances  the  five  necessary  lines,  putting 
i;ii  their  proper  place  the  clef,  the  flats  and  the  sharps. 
Finally,  he  inscribed  the  notes,  at  first  all  in  outline, 
but,  when  he  had  finished,  he  blackened  those  which 
should  be  dark.  The  words  of  the  song  were  written 
below.  On  one  occasion  he  happened  to  write  them 
with  too  large  a  hand,  so  that  they  were  not  placed 
directly  under  their  corresponding  notes.  He  soon 
perceived  this  defect,  and,  in  order  to  amend  it,  he 
blotted  out  what  he  had  done  by  drawing  his  hand  over 
it,  and  then  rewrote  the  line  of  music  lower  down  the 
page  with  all  the  precision  imaginable. 

"Another  singular  thing  of  a  different  sort,  which 
was  not  less  remarkable.  One  night,  in  the  middle  of 
winter,  he  dreamed  that  he  was  walking  on  the  bank  of 
a  river,  and  saw  a  child  fall  into  the  water  where  he 
was  drowning.  The  severity  of  the  cold  did  not  hinder 
him  from  hurrying  to  the  rescue.  He  threw  himself  at 
full  length  upon  his  bed,  in  the  position  of  a  man  who 
is  swimming,  and  imitated  all  his  movements.  After 
having  fatigued  himself  for  some  time  with  this  exer- 
cise, he  felt  a  portion  of  the  coverlid  gathered  in  a 
heap  on  one  corner  of  the  bed.  He  believed  this  to  be 
the  child;  grasped  it  in  one  hand,  and  with  the -other 
went  through   the   motions  of   swimming  back  to  the 


SOMNAMBULISM.  185 

bank  of  the  supposed  river.  There  he  laid  down  his 
burden,  and  came  out,  shivering  and  chattering 
his  teeth  as  if  he  were  really  getting  out  of  an  icy 
river.  To  the  bystanders  he  said  that  he  was  freezing, 
and  would  die  of  cold,  that  his  blood  was  all  turned  to 
ice ;  he  must  have  a  glass  of  brandy  to  warm  him.  Not 
having  any,  they  gave  him  some  water  which  chanced 
to  be  in  the  room;  he  tasted  it,  recognized  the  decep- 
tion, and  called,  with  greater  emphasis  than  before,  for 
brandy,  insisting  upon  the  magnitude  of  the  danger 
which  threatened  his  health.  A  glass  of  liquor  was 
finally  given  to  him;  he  drank  it  with  pleasure,  and 
spoke  of  the  great  relief  which  it  afforded  him.  Not- 
withstanding all  these  incidents,  he  did  not  wake,  but 
went  to  bed,  and  slept  most  profoundly." 

An  equally  instructive  case  is  related  by  my  dis- 
tinguished colleague.  Prof.  J.  Adams  Allen.  ^  The 
subject  of  the  observation  was  a  medical  student  who 
resided  in  Professor  Allen's  house  during  a  portion  of 
the  time  covered  by  the  narrative. 

"  About  the  summer  of  1847,  a  somewhat  dilapi- 
dated bass-viol,  which  was  a  kind  of  heir-loom  in  the 
family,  was  brought  into  the  house,  and  he  devoted 
spare  moments  to  learning  how  to  play  upon  it. 
Unfortunately,  the  antiquity  of  the  instrument  had 
told  upon  its  keys,  and  unless  they  were  wetted  at  each 
time  of  use,  it  would  not  remain  in  tune.  He  was 
determined,  however,  to  command  its  notes,  and  suc- 
ceeded. His  somnambulic  walks,  thereafter,  led  him 
from  his  chamber  to  the  parlor,  and  to  the  bass-viol, 
and  the  family  would  be  awakened  in  the  small  hours 

'  Chicago  Aledical  Journal,  iS6g,  p.  650. 


186  INSOMNIA. 

by  the  inevitable  tuning  up  prelude,  mingled  with 
slipping  of  the  old  keys,  and  quiet  objurgations  upon 
his  part.  Sometimes  the  bridge  would  fall  down  when 
the  keys  slipped,  and  sometimes  a  string  would  snap 
or  escape  from  the  keys,  nevertheless  he  would  perse- 
vere, repair  damages,  tune  up,  and  then  execute  all 
varieties  of  music  of  which  the  machine  was  capable, 
not  unfrequently  accompanying  it  with  his  voice.  All 
this  would  be  done  in  total  darkness.  When  any  one 
entered  the  room  with  a  light,  he  took  not  the  least 
notice,  although  when  spoken  to  he  would  reply  in 
monosyllables  or  with  considerable  asperity.  His  face 
was  usually  flushed,  although  sometimes  pale — the 
features  immobile  and  passive,  the  eye  open,  pupil 
dilated,  the  surface  glazed,  and  the  lids  apparently 
motionless.  The  extremities  warm  and  the  pulse  full, 
frequent  and  soft.  Very  often  the  skin  would  be 
bathed  with  free  perspiration.  Remarkably  sensitive 
to  titillations  when  awake,  there  seemed  total  absence 
of  reflex  movements  from  this  cause  whilst  in  the  som- 
nambulic state. 

"  As  he  extended  his  acquaintance  with  music  and 
musical  instruments,  his  feats  became  wonderful. 
Whilst  in  attendance  upon  the  Medical  College  at  La 
Porte,  the  household  looked  forward  with  high  antici- 
pations to  the  hours  when  his  skillful  touch  of  the 
melodeon  would  wake  them.  He  had  a  voice  of  the 
purest  tone  and  very  considerable  compass,  in  fact  of 
rare  sweetness.  I  am  enabled  to  say  from  a  multitude 
of  observations,  that  he  played  with  a  precision  and 
skill  while  asleep  that  he  could  not  approximate  while 
awake.     Besides  this,  he  would  execute  music  which  he 


SOMNAMBULISM.  187 

liad  heard,  perhaps,  but  once,  the  evening  previous  or 
after  a  long  interval — no  note  of  which  he  could  recall 
in  his  waking  moments.  His  memory  here  seemed 
wonderfully  exalted.  If  interrupted,  he  was  irritable 
in  the  extreme,  but  would  go  on  with  his  music  exactly 
from  the  point  of  interruption. 

"  Among  the  numberless  exhibitions  of  his  som- 
nambulism, I  have  time  only  to  notice  a  few  of  the 
most  striking. 

"  Whilst  attending  lectures  at  Ann  Arbor,  where  I 
was  then  lecturing  on  Physiology,  I  requested  his 
assistance  in  enlarging  some  of  the  drawings  illustra- 
tive of  minute  anatomy  and  histology,  for  use  in  class 
demonstrations.  He  entered  into  the  work  Avith  great 
zeal,  and  proved  very  expert  and  rapid  in  execution. 
One  evening,  previous  to  the  day  on  which  I  was  about 
to  lecture  on  the  kidney,  I  wished  the  cuts  in  Carpen- 
ter's Physiology,  illustrating  the  tubular  arrangement, 
etc.,  were  ready.  He  had  an  engagement  for  the  even- 
ing, but  said  he  would  try  and  prepare  them  in  the 
morning.  During  the  night  he  rose,  dressed  himself, 
played  a  few  tunes  on  the  guitar,  part  of  the  time  sing- 
ing (and,  by  the  way,  the  guitar  was  about  as  dilapi- 
dated as  the  bass-viol  before  noticed,  and  he  had  to 
knot  one  or  two  of  the  strings  first),  and  then  arranged 
the  drawing  paper,  prepared  his  India  ink  and  brushes, 
took  the  parallels  and  pencils  and  laid  off  the  space, 
and  worked  for  half  an  hour  or  more  rapidly  and  per- 
fectly, nearly  completing  the  figures  on  pp.  596  and 
597  of  Carpenter's  Principles,  in  the  edition  of  1853. 
These  drawings  are  now  in  the  series  used  for 
illustration  in  Rush  Medical  College.     Although  we 


188  INSOMNIA. 

had  a  light  in  the  room  while  watching  him,  he  went 
on  with  his  work  entirely  regardless  of  it.  Before 
completing  the  work,  he  went  to  bed  and  slept  until 
the  usual  hour  in  the  morning,  when  at  the  breakfast 
he  asked  if  he  had  been  up  in  the  night,  as  he  had 
dreamed  that  he  had.  This  was  the  only  time  he  ever 
remembered  even  dreaming  about  being  up  or  occu- 
pied in  anything.  He  had  by  this  time  become  so 
fully  aware  of  his  habits,  that  nothing  of  the  sort 
astonished  him.  Shortly  after  this  he  went  to  spend 
the  night  with  a  fellow  student,  but  a  little  after  mid- 
liight  he  rose,  dressed  himself,  and  went  out,  followed 
by  the  other  gentleman,  walked  down  to  the  Exchange 
Hotel,  where  there  were  a  number  of  his  acquaint- 
ances and  others  waiting  for  a  train  of  cars  due  at  that 
time.  Some  one  rallied  him  on  his  being  out  so  late, 
but  being  cautioned  by  his  companion,  they  did  not 
attempt  to  awake  him,  but  watched  his  movements. 
On  being  invited,  he  took  a  glass  of  ale,  and  then  said 
he  would  only  have  time  to  go  home  and  get  his  dinner 
before  the  afternoon  lecture  hour.  He  walked  with 
his  friend  to  our  door,  and  was  indignant  to  find  it 
locked.  His  room-mate  (a  cousin)  admitted  him, and 
awakened  myself  and  wife.  He  asked  if  dinner  was 
ready,  and  seemed  astonished  that  it  was  not ;  then  said 
he  would  get  a  drink  of  water  and  be  off,  '  for  old  D. 
(one  of  the  faculty)  would  be  mad  if  he  was  late.'  I 
told  him  he  had  plenty  of  time  and  he  need  not  be  in 
a  hurry.  He  then  walked  into  the  kitchen,  drank  a 
tumblerful  of  water,  and,  looking  up  to  the  clock, 
although  it  was  totally  dark,  remarked  the  time,  and 
started  for  the  front  door.     I  then  told  him  that  I  was 


SOMNAMBULISM.  189 

not  feeling  well,  was  pretty  blue,  and  wished  lie  would 
sit  down  and  play  euchre  with  us.  This  seemed  to 
please  him,  and  he  took  off  his  overcoat  and  said  he 
had  as  lief  play  until  'old  D.'  was  through  lecturing, 
as  to  go. 

"  His  cousin  sat  down  at  the  table  with  us,  and  we 
played  '  three-handed  (cut-throat)  euchre.'  He  paid 
not  the  slightest  attention  to  us,  although  we  passed 
the  cards  backwards  and  forwards  between  us,  exchang- 
ing hands,  and  everything  we  could  do  to  attract  his 
attention.  He  dealt  the  cards  in  his  turn,  correctly, 
and  played  '  according  to  Hoyle.'  In  one  hand,  spades 
were  trumps,  and  he  held  the  jack  of  clubs.  Clubs 
being  led,  he  first  threw  down  this  jack,  then  quickly 
picked  it  up,  saying,  '  I  forgot  that  was  the  left  bower.' 
It  is  somewhat  humiliating  to  record  that,  notwith- 
standing our  tricks  and  devices,  he  beat  us  in  the 
game. 

"  On  its  conclusion,  he  got  up  hastily  and  insisted 
upon  going  to  the  college.  We  only  prevented  him 
this  time,  by  throwing  water  in  his  face — the  only 
method,  by  the  way,  in  which  we  could  awake  him 
without  great  violence.  Pungent  odors,  ammonia, 
camphor,  etc.,  he  seemed  to  disregard,  or  merely 
pushed  away  the  object. 

"  On  regaining  consciousness,  he  always  appeared 
like  one  stunned,  or  suffering  from  a  severe  shock. 
The  influence  upon  the  pulse  and  nervous  system  was 
always  so  severe,  that  we  never  awaked  him  at  these 
times  if  we  could  avoid  it. 

"  Whenever  a  little  out  of  health,  as  from  trifling 
attacks  of  indigestion,  or  after  watching  with  the  sick, 


190  INSOMNIA. 

or  fatigue,  he  would  be  sure  to  be  up  and  doing  some- 
thing notable  in  the  somnambulic  state. 

"  One  of  the  most  remarkable  of  his  exploits  occurred 
several  years  after  the  incident  just  given.  I  think  it  was 
in  1860  or  1861.  ...  In  the  rounds  of  his  prac- 
tice he  had  a  patient,  about  whom  he  was  very  anxious. 
It  was  in  the  coldest  winter  weather,  and  the  residence 
of  the  patient  was  about  two  miles  distant.  Visiting 
him  early  in  the  evening,  he  found  him  in  a  state  so 
unsatisfactory,  that  he  informed  the  family  that  if  he 
did  not  find  him  better  the  next  visit,  he  should  change 
the  medicine  entirely.  On  rising  the  next  morning, 
he  went  to  the  barn  to  put  his  horse  to  the  cutter  for 
an  early  start.  He  was  a  little  puzzled  at  finding 
things  somewhat  misplaced,  but  supposed  some  person 
had  been  at  the  stable  in  search  of  a  missing  article. 
On  visiting  the  patient,  he  was  gratified  to  find  a 
marked  improvement.  He  inquired  when  the  improve- 
ment commenced,  and  was  answered,  '  Immediately 
after  taking  the  powders  which  he  had  given  in  the 
night.'  The  truth  flashed  upon  him  at  once,  but  con- 
cealing his  emotion,  he  inquired,  with  as  careless  an 
air  as  he  could  assume,  '  About  what  time  was  it  when 
I  was  here?  '  They  replied,  'Between  two  and  three 
o'clock.'  This  proved  to  have  been  the  case,  as  he 
was  afterwards  told  by  the  family  where  he  boarded. 
He  had  been  giving  the  patient  some  fluid  medicine, 
which  he  ordered  discontinued,  and  then  put  up  several 
powders,  such  as  he  had  concluded  upon  the  night 
previous,  combining  them  as  usual,  and  administering 
the  first  one  himself." 

The  foregoing  examples    illustrate    the    fact    that 


SOMNAMBULISM.  191 

ordinary  vision  is  not  necessary  to  guide  the  move- 
ments of  the  somnambulist.  Sometimes  the  patient 
walks  about  with  open  eyes;  on  other  occasions  they 
are  firmly  closed.  It  is  generally  admitted  that  the 
tactile  and  muscular  senses  are  greatly  exalted,  so  that 
they  furnish  guiding  sensations  which  are  sufficient  to 
direct  the  most  complicated  movements.  The  history 
of  the  medical  student  observed  by  Dr.  Allen  shows 
how  preternaturally  sensitive  the  organs  of  vision  may 
become — actually  seeing  the  clock  in  the  dark  during 
the  somnambulic  paroxysm.  When  one  considers  the 
remarkably  hypersesthetic  condition  of  the  senses  in 
certain  other  forms  of  nervous  disorder,  it  is  not  sur- 
prising that  sensory  impressions  which  would  be 
wholly  neglected  in  a  healthy  waking  state,  may 
become  sufficient  to  excite  perceptions  and  to  guide 
the  movements  which  they  have  aroused.  It  is 
undoubtedly  true  that  in  certain  cases  the  somnam- 
bulist does  derive  some  information  through  the  me- 
dium of  the  eyes — does  really  see ;  but  it  is  also  a  fact 
that  he  only  sees,  hears,  tastes  and  feels  the  objects 
which  are  immediately  related  with  the  action  of  his 
dream.  It  appears  also  that  an  impression  derived 
from  any  organ  of  sense  may  suffice  to  arouse  any 
other  or  all  of  the  internal  organs  of  perception,  so 
that  the  patient  seems  to  see,  to  hear,  and  even  to 
taste  objects  which  he  knows  only  through  the  sense  of 
touch.  Sometimes  the  image  thus  externalized  coin- 
cides with  the  actual  reality;  but  often  this  is  not  the 
case,  as,  in  the  experience  of  the  young  clergyman, 
the  somnambulist  seemed  to  see  the  paper  which  he 
only  perceived  through  contact  with  his  fingers.     The 


192  INSOMNIA. 

image  thus  created  corresponded  exactly  with  the 
external  fact;  but  when  a  similar  contact  with  a  pile 
of  bed-clothes  excited  the  illusion  of  a  drowning 
child  in  his  grasp,  the  internal  image  did  not  in  the 
least  correspond  with  the  external  object,  and  he 
probably  derived  no  information  through  the  sense 
of  sight  in  either  case.  In  another  instance,  how- 
ever, as  we  shall  learn  upon  another  page,  the  subject 
is  so  far  dependent  upon  the  sense  of  sight  that  its 
obstruction  is  sufficient  to  arrest  his  movements,  as 
certainly  as  if  he  were  awake. 

Ordinarily  the  memory  is  not  impressed  by  the 
events  of  the  somnambulic  dream,  but  we  have  already 
learned  that  it  is  sometimes  affected  precisely  as  in 
common  dreaming.  One  of  my  little  acquaintances 
could  not  find  her  night-dress  when  she  went  to  bed 
one  night.  She  was  therefore  obliged  to  wear  a  gown 
that  was  old  and  ragged.  Later  in  the  evening  her 
sister  discovered  the  missing  garment,  and  laid  it  over 
a  chair  in  the  bed-room.  In  the  morning  the  night- 
dresses had  changed  place,  and  the  ragged  one  occu- 
pied the  chair.  This  occasioned  considerable  surprise, 
until  the  child  remembered  that  during  the  night  she 
had  dreamed  that  two  of  her  playmates  had  come  to 
sleep  with  her,  and  that  she  felt  so  mortified  at  being 
seen  in  a  ragged  dress  that  she  got  out  of  bed  and 
changed  her  night-gown.  Sometimes  the  events  of  a 
somnambulic  paroxysm  are  remembered  during  a 
subsequent  attack,  though  they  are  forgotten  during 
the  interval,  as  in  a  case,  reported  by  Macario,  of  a 
young  girl  who  had  been  violated  during  somnam- 
bulic sleep.     On  awaking  she  had  no  idea  of  anything 


SOMNAMBULISM.  193 

that  had  occurred,  but  during  a  subsequent  paroxysm 
she  told  her  mother  all  that  had  happened.^  In  cer- 
tain cases  a  dim  recollection  of  some  particular  inci- 
dent may  be  retained,  as  in  the  case  of  my  patient 
Avho  was  for  eight  weeks  in  the  somnambulic  state. 
On  recovery,  the  only  thing  that  she  could  remember 
was  a  momentary  glimpse  of  some  one  who  was  hold- 
ing up  his  fingers  before  her  eyes.  Meeting  the  phy- 
sician, subsequently  to  her  recovery,  who  had  thus 
attempted  to  arouse  her  attention,  she  recognized  in 
his  countenance  the  features  which  had  momentarily 
impressed  her  consciousness  during  the  period  of 
somnambulic  life. 

It  is  seldom  observed  that  somnambulism  is  attended 
with  dangerous  tendencies,  yet  they  are  sometimes 
present.  One  of  my  patients  once  took  by  mistake 
ninety  grains  of  chloral  at  a  single  dose.  While  under 
its  effects  she  got  out  of  bed,  walked  into  her  sister's 
room,  shook  her  fist  in  her  face,  and  swore  furiously  at 
her.  On  awaking,  next  morning,  she  was  greatly 
shocked  by  the  account  of  this  dreadful  behavior,  so 
utterly  at  variance  with  her  usual  temper  and  charac- 
ter. Another  somnambulic  patient  one  night  rushed 
into  her  mother's  room,  violently  accusing  her  of  steal- 
ing her  pocket-book,  and  threatening  vengeance  if  it 
were  not  returned.  Such  patients  sometimes  mislay 
the  articles  with  which  they  occupy  themselves  during 
a  paroxysm,  and  on  waking  they  erroneously  infer  that 
they  have  been  robbed.  Sometimes,  as  in  the  cele- 
brated case  related  by  Mesnet,  the  natural  propensities 
of  the  individual  seem  to  be  released  from  all  restraint, 

'  Maury,  Le  Sommeil  et  les  Rives,  p.  234. 
13 


194  INSOMNIA. 

and  brutal  instincts  guide  the  actions  of  the  somnam- 
bulist, who  then  steals,  or  eats  and  drinks  with  the 
voracity  of  a  savage.  Ball  and  Chambard  [loc.  cit) 
have  collected  a  number  of  examples  in  which -impulses 
to  suicide  or  other  forms  of  violence  were  manifested 
under  such  circumstances.  Obviously,  where  the 
moral  sense  is  asleep,  and  where  the  affection  is  the 
result  of  causes  beyond  the  control  of  the  patient,  he 
cannot  be  held  morally  responsible  for  the  conse- 
quences of  such  actions.  His  condition  closely  resem- 
bles that  of  the  victim  of  epileptic  mania  who  delivers 
himself  during  a  paroxysm  to  all  degrees  of  furious 
and  homicidal  violence,  without  retaining  the  slightest 
recollection  of  the  fact  after  its  conclusion.  The  close- 
ness of  the  parallel  between  these  two  disorders  is 
rendered  further  apparent  by  the  circumstance  that 
although  all  memory  of  the  events  of  epileptic  mania 
is  usually  abolished,  it  does  sometimes  persist  after  the 
termination  of  the  attack.  Thus,  one  of  my  epileptic 
patients  for  a  time  manifested  symptoms  of  insanity 
after  every  fit.  During  one  of  these  paroxysms  he 
imagined  that  the  sparrows  on  the  housetop  were  all 
singing  a  particular  tune  which  had  attracted  his  atten- 
tion shortly  before  the  convulsion.  Then  it  seemed  to 
him  that  the  breathing  of  his  sleeping  child  whispered 
the  same  tune.  Placing  his  hand  upon  the  bosom  of 
his  wife,  her  breathing  assumed  the  same  musical 
character.  Calling  upon  his  family  to  listen  to  the 
wonderful  music,  they  all  asserted  that  they  too  could 
hear  it.  It  was  a  considerable  time  after  his  recovery 
before  he  could  be  convinced  that  this  vividly  remem- 
bered experience  was  a  pure  illusion.     The  members 


SOMNAMBULISM.  195 

of  his  family  had  been  cautioned  against  contradicting 
their  father  during  his  paroxysms ;  consequently,  when 
he  asked  if  they  could  hear  the  melody  which  delighted 
him,  they  answered  affirmatively,  and  thus  confirmed 
him  in  his  delusion.  To  the  ordinary  form  of  epileptic 
mania  such  paroxysms  sustain  a  relation  similar  to  that 
subsisting  between  ordinary  dreams  and  the  somnam- 
bulic experience. 

In  like  manner  as  it  is  often  remarked  that  certain 
dreams  betray  a  condition  of  unusual  cerebral  excite- 
ment, so  do  certain  cases  of  somnambulism  manifest  a 
delirious  exaltation  of  the  faculties  in  action.  This 
characteristic  often  belongs  to  the  night-terrors  of 
children.  It  is  a  condition  in  which  the  brain  is  occu- 
pied by  the  scenery  of  a  vivid  and  highly  dramatic 
vision  which  dominates  the  actions  of  the  subject. 
This  was  most  conspicuously  shown  in  the  following 
case,  from  J.  P.  Frank,  ^  and  in  certain  periods  of  the 
paroxysms  observed  by  Mesnet  (p.  198).  Frank's 
patient  was  a  healthy  and  well  nurtured  young  Ger- 
man girl,  who  during  the  wars  of  1812  had  been  terri- 
bly alarmed  by  a  party  of  French  soldiers  who  had 
broken  into  the  house  and  threatened  to  kill  her  father. 
The  next  day  at  the  same  hour  she  passed  into  a  som- 
nambulic state,  which  lasted  till  sunset.  After  a  brief 
introductory  period  of  agitation,  she  uttered  a  deep 
sigh,  which  was  rather  a  sob  than  a  sigh,  and  fell  into  a 
profound  sleep.  Presently  she  smiled,  her  countenance 
seemed  lighted  with  inspiration,  her  right  arm  was 
raised  in  the  air,  and  the  left  was  directed  towards  the 
earth.     In  this   cataleptic   attitude   she  remained  for 

'  Pathologic  interne. 


196  INSOMNIA. 

about  a  minute.  She  then  seemed  to  have  decided 
what  to  do;  from  an  imaginary  cartridge-box  behind 
her  back  she  pulled  out  a  cartridge,  bit  off  the  end, 
poured  out  the  powder  upon  her  fist  as  if  she  were 
priming  a  musket.  She  then  went  through  the  motions 
of  loading  a  gun,  ramming  down  the  wad  with  an 
imaginary  ramrod,  and  cried  out  in  French,  a  language 
which  she  had  never  heard  before:  "Marche!  Ou  est 
le  baron?  Sacre  nom  de  Dieu!"  Repeating  the 
violent  ejaculations  and  threats  addressed  by  the 
soldiers  to  her  father,  she  exhibited  the  utmost  terror; 
her  body  was  covered  with  a  cold  sweat,  and  she  seemed 
ready  to  faint  away.  At  this  moment  she  woke  up, 
called  impatiently  for  her  handkerchief,  with  which 
she  wiped  the  perspiration  from  her  face,  and  resumed 
her  ordinary  avocations  as  if  nothing  had  happened." 

Still  more  remarkable  was  the  case  reported  by  Dr. 
Mesnet.'  From  the  excellent  translation  prepared  by 
T.  J.  Huse,  M.  D.,^  the  following  sketch  has  been  out- 
lined : 

The  patient,  aet.  27  years,  received  in  one  of  the 
battles  near  Sedan,  during  the  Franco-Prussian  war, 
a  bullet  wound  which  fractured  the  left  parietal  bone. 
His  right  arm  was  almost  immediately  paralyzed ;  after 
a  few  minutes  the  paralysis  involved  the  right  leg,  and 
he  lost  consciousness.  It  was  only  after  the  lapse  of 
three  weeks  that  he  recovered  his  senses.  He  was 
finally  taken  to  Paris,  where  the  paralysis  gradually 
disappeared.  From  a  period  some  three  or  four 
months  after  the  reception  of  the  injury,  he  began  to 

^/-'  Union  MMicale,  July  21st  and  23d,  1874. 

^  Chicago  Jou7-n.  of  Nervous  aiid  Mental  Diseases^  Vol.  II,  p.  48. 


SOMNAMBULISM.  197 

manifest  periodical  attacks  of  somnambulism,  at  inter- 
vals of  fifteen  to  thirty  days  with  an  average  duration 
of  fifteen  to  thirty  hours.  During  the  whole  of  this 
time  his  life  presented  two  essentially  distinct  phases 
— the  one  normal,  the  other  pathological.  In  the 
normal  condition  he  was  able  to  gain  a  livelihood.  He 
had  been  a  clerk  in  several  houses,  a  singer  in  a  caf6, 
and  while  in  the  hospital  had  made  himself  useful  and 
agreeable.  The  somnambulic  attacks  which  he  experi- 
enced were  characterized  by  an  instantaneous  onset, 
resulting  in  the  abolition  of  all  his  senses  except  the 
tactile  sense.  Sight  was  perhaps  partially  persistent, 
for  on  many  occasions  he  seemed  to  be  impressed  by 
brilliant  objects,  but  he  was  obliged  to  employ  the 
sense  of  touch  in  order  to  understand  their  form, 
volume,  etc.  During  all  these  crises  his  gait  was  easy, 
his  attitude  calm,  his  countenance  peaceful;  his  eyes 
were  widely  open,  with  dilated  pupils;  the  forehead 
and  brows  were  contracted;  there  was  an  incessant 
nystagmus,  indicating  a  disordered  state  in  the  brain; 
he  was  continually  mumbling  or  muttering.  When 
walking  in  a  familiar  locality  he  moved  with  perfect 
freedom ;  but  if  in  a  strange  place,  or  if  obstacles  were 
placed  in  his  way,  he  examined  the  obstructions  by 
feeling  of  them  with  his  hands,  and  turned  easily  aside. 
If  any  attempt  was  made  to  change  his  direction,  or  to 
quicken  or  retard  his  pace,  he  allow^ed  himself  to  be 
directed  like  a  mere  automaton,  continuing  to  walk  in 
any  way  thus  chosen  for  him.  He  would  also  eat, 
drink,  smoke,  dress  himself,  walk  out,  and  retire  to  bed 
as  usual.  These  processes  seemed  to  be  effected  as  a 
result  of  previous  habit,  without  any  actual  conscious- 


198  INSOMNIA. 

ness  or  feeling.  He  ate  voraciously  without  discern- 
ment, and  drank  in  the  same  manner  ordinary  wine, 
wine  of  quinine,  water,  assafoetida,  without  exhibiting 
any  evidence  of  sensation  whatever. 

While  under  treatment  in  the  Saint  Antoine  Hos- 
pital, this  patient  was  carefully  studied  by  Dr.  Mesnet 
and  by  Alfred  Maury,  the  celebrated  author.  They 
found  that  by  means  of  impressions  upon  his  tactile 
sensibility  it  was  possible  during  any  one  of  his 
paroxysms  to  suggest  certain  modes  of  action  which 
Avere  reproduced  whenever  he  was  again  placed  in  the 
same  conditions.  Thus,  "  he  was  promenading  in  the 
garden,  under  a  grove  of  trees,  when  some  one  put 
back  into  his  hand  the  cane  which  he  had  let  fall  a 
few  moments  previously.  He  felt  of  it,  turned  his 
hand  several  times  around  the  curved  handle  of  the 
cane,  became  attentive,  seemed  to  listen,  and  suddenly 
cried  out,  '  hurry ! '  then,  '  there  they  are !  there  are  at 
least  twenty  of  them,  to  the  two  of  us!  we  shall  get  the 
better  of  them ! '  and  then,  carrying  his  hand  behind 
his  back,  as  if  to  get  a  cartridge,  he  went  through  the 
movements  of  loading  his  musket,  crouched  at  full 
length  in  the  grass,  concealing  his  head  behind  a  tree, 
in  the  posture  of  a  sharp-shooter,  and  following  with 
his  gun  at  his  shoulder  all  the  movements  of  the 
enemy  whom  he  seemed  to  see  close  at  hand.  This 
scene  often  repeated  in  detail  during  the  course  of  the 
observations,  has  seemed  to  each  of  us  the  most  com- 
plete expression  of  an  hallucination  called  up  by  an 
illusion  of  touch,  which,  giving  to  a  cane  the  proper- 
ties of  a  gun,  awakened  in  this  person  remembrances 


SOMNAMBULISM  199 

of  liis  last  campaign,  and  reproduced  the  struggle  in 
which  he  was  so  grievously  wounded." 

On  another  occasion  the  patient  was  at  the  end  of  a 
corridor,  near  a  door  that  was  locked;  he  "passed  his 
hands  over  this  door,  found  the  knob,  grasped  it,  and 
attempted  to  open  it;  failing  to  accomplish  this,  he 
sought  for  the  keyhole,  then  for  the  key,  which,  how- 
ever, was  not  there;  then,  passing  his  fingers  over  the 
screws  which  secured  the  lock,  he  endeavored  to  seize 
them  and  turn  them  for  the  purpose  of  detaching  the 
lock.  This  entire  series  of  actions  hears  witness  to  an 
effort  of  his  mind  connected  with  the  object  before  him. 
He  was  on  the  point  of  leaving  the  door  and  turning 
towards  another  room,  when  I  held  up  before  his  eyes 
a  bunch  of  seven  or  eight  keys ;  he  did  not  see  them ;  I 
jingled  them  loudly  at  his  ear ;  he  did  not  notice  them ; 
placing  them  in  his  hand,  he  immediately  took  hold  of 
them,  and  tried  them  one  by  one  in  the  keyhole,  with- 
out finding  the  single  one  which  could  fit;  he  then  left 
the  place,  and  went  into  one  of  the  wards,  taking  in  his 
passage  various  articles  with  which  he  filled  his  pockets ; 
at  length  he  came  to  a  little  table  used  for  the  records 
of  the  wards.  He  then  passed  his  hands  over  the 
table,  but  it  was  empty;  in  feeling  of  it,  however,  he 
came  across  the  handle  of  a  drawer ;  opening  it,  he  took 
up  a  pen,  and  all  at  once  this  pen  suggested  to  him  the 
idea  of  icriting;  for  at  that  moment  he  began  to  ran- 
sack the  drawer,  taking  out  and  placing  on  the  table 
several  sheets  of  paper,  and  also  an  inkstand.  He  then 
sat  down  and  commenced  a  letter,  in  which  he  recom- 
mended himself  to  his  commanding^  officer  for  his  orood 
conduct   and  bravery,    and  made  ^plication  for  the 


200  INSOMNIA. 

military  medal.  This  letter  was  written  with  many 
mistakes  in  it,  but  these  were  identical  as  regards 
expression  and  orthography  with  all  that  we  have  seen 
him  make  in  his  healthy  state.  While  the  patient  was 
writing,  he  aided  us  in  an  experiment  that  encouraged 
to  immediately  examine  in  what  degree  the  sense  of 
sight  assisted  in  the  performance  of  this  action.  The 
facility  with  which  he  traced  his  letters,  and  followed 
the  lines  upon  the  paper,  left  no  doubt  concerning  the 
exercise  of  vision  upon  the  writing;  but,  in  order  to 
make  the  proof  satisfactory,  we  have  several  times 
interposed  a  thick  plate  of  sheet-iron  between  his 
hands  and  his  eyes  when  he  was  writing ;  and,  although 
all  the  visual  rays  were  intercepted,  he  did  not  imme- 
diately break  off  the  line  he  had  begun;  he  still  con- 
tinued to  trace  a  few  words  written  in  an  almost 
illegible  manner  with  the  letters  entangled  in  each 
other;  then  finally  he  stopped  without  manifesting 
either  discontent  or  impatience.  The  obstacle  removed, 
he  finished  the  uncompleted  line,  and  began  another. 
The  sense  of  sight  was  therefore  in  full  activity ^  and 
essential  to  the  written  expression  of  the  patieMV  Other 
observations  showed  that  the  sense  of  sight  was  only 
roused  at  the  instance  of  touch,  and  that  its  exercise 
remained  limited  to  those  objects  alone  with  which  it 
was  actually  connected  by  the  touch. 

On  another  occasion  he  passed  through  a  long  ward 
of  patients,  "  taking  indiscriminately  every  article  that 
came  within  his  reach,  and  concealing  them  afterwards 
under  the  quilt,  under  a  mattress,  under  a  chair-cover, 
and  under  a  pile  of  sheets.  Arrived  in  the  garden,  he 
took  from  his  pocket  a  book  of  cigarette  papers,  opened 


SOMNAMBULISM.  201 

it,  and  detached  a  leaf  from  it;  then  took  out  his 
tobacco  and  rolled  a  cigarette  with  the  dexterity  of  one 
who  is  accustomed  to  this  proceeding.  He  searched 
for  his  match-box,  lighted  his  cigarette  with  a  match, 
which  falling  still  burning  on  the  ground,  he  extin- 
guished by  placing  his  foot  upon  it ;  then  smoked  his 
cigarette  while  strolling  back  and  forth  to  the  entire 
extent  of  the  garden,  without  any  of  these  actions  pre- 
senting the  slightest  deviation  in  their  manner  from 
the  ordinary  method.  Everything  that  he  did  was 
the  faithful  reproduction  of  his  ordinary  round  of 
life. 

"This  first  cigarette  terminated,  he  prepared  to 
make  another,  ,when  we  stepped  up  and  began  to  inter- 
pose obstacles.  .  .  .  He  searched  vainly  in  his 
pocket  for  his  tobacco,  as  we  had  filched  it.  He 
searched  for  it  in  another  pocket,  going  through  all  his 
clothes  until  he  came  back  to  look  for  it  in  the  first 
pocket,  when  his  face  expressed  surprise.  I  offered 
him  his  tobacco-pouch,  but  he  did  not  perceive  it;  I 
held  it  near  his  eyes,  yet  he  still  did  not  perceive  it; 
even  when  I  shook  it  just  in  front  of  his  nose,  he  did 
not  notice  it.  But  when  I  placed  it  in  contact  with  his 
hand,  he  seized  it  and  completed  his  cigarette  directly. 
Just  as  he  was  about  to  light  his  cigarette  with  one  of 
his  matches,  I  blew  it  out  and  offered  him  instead  a 
lighted  match  which  I  held  in  my  own  hand;  he  did 
not  perceive  it;  I  brought  it  so  close  to  his  eyes  as  to 
singe  a  few  lashes,  yet  he  still  did  not  perceive  it, 
neither  did  he  make  the  slightest  motion  of  blinking. 
.  .  .  The  patient  sees  certain  objects  and  does  not 
perceive  others ;    his   sense  of  sight   receives   impres- 


202  INSOMNIA. 

sions  from  all  objects  in  personal  relation  with  him- 
self through  the  touch,  and  does  not  receive  impres- 
sions, on  the  contrary,  from  things  external  to  him  ;  he 
perceives  his  own  match,  hut  does  not  perceive  mine^ 

During  the  course  of  this  observation  the  patient 
gave  evidence  that  the  memory  of  his  former  occupa- 
tion as  a  professional  singer  had  been  revived.  He 
began  to  hum  some  of  the  familiar  airs,  and  then  pro- 
ceeded to  his  room  in  the  hospital,  where  he  carefully 
dressed  himself  as  if  for  a  public  performance.  "  On 
his  bed  he  chanced  to  meet  with  several  numbers  of  a 
periodical  romance,  which  he  turned  rapidly  over  with- 
out finding  that  for  which  he  was  searching. 
I  took  one  of  those  numbers,  rolled  it  up,  and  putting 
it  into  his  hand  in  that  condition,  satisfied  his  want 
by  this  semblance  of  a  roll  of  music,  for  he  then  took 
his  cane,  and  traversed  the  ward  with  a  slow  step,  well 
contented.  When  stopped  on  his  way,  for  the  purpose 
of  taking  off  the  coat  he  was  wearing  (which  had  been 
foisted  on  him  by  one  of  the  observers),  he  permit- 
ted it  without  offering  any  resistance.  ...  At 
this  moment  the  sun  lit  up  with  a  bright  ray  a  glass 
window  that  closed  the  lodge  on  the  side  towards  the 
court.  .  .  .  This  ray  must  have  given  him  the 
impression  of  a  footlight,  for  he  at  once  placed  him- 
self before  it,  readjusted  his  toilet,  opened  the  roll  of 
paper  which  he  carried  in  his  hand,  and  softly  hummed 
an  air,  running  his  eyes  over  the  pages  as  he  slowly 
turned  them,  and  marking  with  his  hand  a  measure 
that  was  perfectly  rhythmical.  Then  he  sang  aloud, 
in  a  highly  agreeable  manner,  giving  his  song  the 
correct  expression,  a  patriotic  ballad  to  which  we  all 


SOMNAMBULISM.  203 

listened  with  pleasure.  This  first  selection  termina- 
ted, he  sang  a  second,  and  afterwards  a  third.  We 
then  saw  him  take  out  his  handkerchief  to  wipe  his 
face.  I  offered  him  a  wine-glass  of  a  strong  mixture 
of  vinegar  and  water,  which  he  did  not  notice ;  I  placed 
the  glass  under  his  nose  without  his  perceiving  the 
smell  of  the  vinegar;  I  put  it  into  his  hand,  and  he 
drank  it  without  complaining  of  any  unpleasant  sen- 
sation.'- 

The  conclusions  which  may  be  drawn  from  this 
remarkable  history  have  been  sufficiently  expressed  by 
Dr.  Mesnet^  in  the  following  words: 

"  The  disturbance  which  these  functional  perversions 
of  the  nervous  system  bring  into  the  course  of  life, 
extends  not  only  to  the  organs  of  sense,  and  to  intel- 
lectual actions  properly  so  called,  but  it  also  some- 
times awakens  some  instinctive  excitation  which 
surrenders  the  individual  without  any  defence,  and 
destitute  of  rational  discernment,  to  the  most  deplora- 
ble impulses.  He  acts  with  the  semblance  of  a  free- 
dom which  he  does  not  possess ;  he  seems  to  prepare 
and  to  combine  certain  actions  in  the  light  of  conscious 
volition,  when  he  is  in  reality  only  a  blind  instrument, 
obedient  to  the  irresistible  mandates  of  an  unconscious 
impulse." 

The  bearing  of  these  conclusions  upon  the  ques- 
tion of  the  moral  responsibility  of  the  somnambulist 
needs  no  further  advertisement. 

The  likeness  of  certain  features  of  such  cases  to 
the  phenomena  of  hypnotism  is  worthy  of  note.  In 
this  particular  there  is  an  evident  likeness  between  the 

^  Loc.  cit. 


204  INSOMNIA. 

cerebral  susceptibility  of  the  ordinary  dreamer,  the 
somnambulist,  and  the  hypnotised  subject.  All  are 
alike  in  a  condition  which  renders  their  imagination 
and  their  volition  subservient  to  guiding  sensations 
from  without,  so  that  their  movements  may  be  directed 
by  the  will  of  another.  We  have  seen  how  the  course 
of  an  ordinary  dream  may  be  modified  by  such  sugges- 
tions. The  history  of  the  patient  just  related,  illus- 
trates the  manner  in  which  the  actions  of  a  somnam- 
bulic dreamer  may  be  controlled  by  the  will  of  a 
spectator.  The  ordinary  phenomena  of  hypnotism 
exhibit  the  same  subjection  to  the  will  of  another.  It 
is  probable  that  a  considerable  part  of  the  superior 
notoriety  which  belongs  to  this  feature  of  hypnotism,  is 
due  merely  to  the  fact  that  natural  somnambulism  is 
rarely  made  the  object  of  such  experiments  and  obser- 
vations as  are  daily  applied  to  the  subjects  of  artificial 
somnambulism. 

Somnambulic  Life. — We  come  now  to  the  last  term 
of  the  series,  the  simplest,  yet  perhaps  the  rarest 
form  of  the  affection.  In  this  form,  the  patient  seems 
perfectly  awake ;  he  is  in  possession  of  all  his  senses ; 
he  is  capable  of  sustained  and  rational  volition;  he 
lives  and  behaves,  in  short,  like  any  other  person.  But 
his  life  is  divided  into  periods  which  are,  so  far  as 
consciousness  is  concerned,  completely  distinct  from 
each  other.  This  double-consciousness  may  be  exhib- 
ited but  once  in  a  lifetime,  or  it  may  be  frequently 
repeated,  so  that  the  patient  oscillates  between  the  two 
states  until  it  becomes  doubtful  which  is  the  natural 
condition  and  which  is  the  acquired.  These  states  of 
double-consciousness  are  divided  from  each  other  by  a 


SOMNAMBULIC   LIFE.  205 

more  or  less  complete  break  in  the  chain  of  memory. 
The  residual  strata  which,  so  to  speak,  have  been 
deposited  from  the  sea  of  events  upon  the  floor  of 
memory,  have  become  broken  and  "faulted."  The 
line  of  rupture  marks  the  division  between  the  two 
fields  of  consciousness ;  they  no  longer  lie  in  the  same 
plane,  consequently  there  can  be  little  or  no  continu- 
ity of  memory  between  them.  The  events  which 
transpire  in  one  state  affect  the  mind  so  long  as, 
and  whenever  it  is  in  connection  with  the  cerebral 
register  which  is  fitted  to  that  state;  as  soon  as  the 
connection  is  shifted,  the  mind  takes  cognizance  of 
the  events  that  are  recorded  upon  the  other  portion 
of  the  register,  but,  for  want  of  physical  continuity 
between  the  different  portions  of  the  record,  the  mind 
cannot  at  once  receive  a  continuously  connected  report 
from  the  entire  organ  of  recollection.  From  this 
lesults  a  mode  of  life  essentially  similar  to  the  life  of 
certain  epileptics  who  are  ushered  by  each  seizure  into 
a  state  of  apparently  conscious  activity  of  which  they 
have  no  recollection  after  recovery.  Thus,  one  of  my 
epileptic  patients,  who  was  subject  to  seizures,  both 
of  the  convulsive  and  the  non-convulsive  form  of  the 
disease,  on  one  occasion  left  home,  after  a  fit,  and 
traveled  a  considerable  distance  into  the  country,  put- 
ting up  for  the  night  at  taverns  and  farm  houses,  and 
apparently  behaving  like  any  other  respectable  citi- 
zen. It  was  three  weeks  before  he  came  to  himself. 
On  recovering  his  normal  consciousness,  the  period 
of  his  wanderings  was  a  perfect  blank  in  his  memory. 
Such  attacks  are  usually  of  shorter  duration,  and  are 
more  frequently  associated  with  hysteria ;  bearing  to 


206  INSOMNIA. 

the  hysterical  paroxysm  the  same  relation  which  they 
share  with  the  epileptic  fit.  When  the  predisposing 
temperament  exists,  a  great  variety  of  excitations  may 
serve  to  produce  the  phenomena,  so  that  unless  care- 
ful observation  is  employed,  the  truly  somnambulic 
character  of  the  paroxysm  may  easily  be  overlooked. 
Thus,  the  true  nature  of  the  affection  was  not  sus- 
pected by  the  early  attendants  of  the  patient  who 
became  the  subject  of  lethargic  stupor,  as  l-elated  on 
page  173.  Under  the  influence  of  powerful  drugs  act- 
ing upon  a  highly  sensitive  nervous  organization,  she 
became,  at  first,  "  hystericky."  She  manifested  great 
distress,  complained  bitterly  of  her  sufferings,  passed 
through  the  ordeal  of  several  consultations,  was  sub- 
jected to  a  considerable  surgical  operation,  and  only 
ceased  to  appear  conscious  at  the  expiration  of  five 
weeks,  when  she  passed  into  the  lethargic  state  previ- 
ously described.  At  the  time  of  my  first  visit,  just 
before  the  commencement  of  stupor,  she  walked  into 
the  room  where  I  was  waiting,  greeted  me  with  her 
usual  affability,  gave  me  some  account  of  her  sensa- 
tions, and  neither  did  nor  said  anything  that  could 
lead  me  to  suspect  that  she  was  not  in  her  normal 
frame  of  mind.  But,  with  the  exception  of  the  single 
incident  mentioned  on  page  193,  the  entire  period  from 
the  commencement  of  her  medication  to  the  close  of 
the  lethargic  stupor  was  utterly  blotted  out  of  her 
recollection. 

Macnish'  relates  a  similar  case  of  a  young  lady  who 
'*  unexpectedly,  and  without  any  forewarning,  fell  into 
a  profound  sleep  which  continued  several  hours  beyond 

^  Philosophy  of  Sleep,  p.  167. 


SOMNAMBULIC  LIFE.  207 

the  ordinary  term.  On  waking,  she  was  discovered  to 
have  lost  every  trace  of  acquired  knowledge.  Her 
memory  was  tabula  rasa  —  all  vestiges,  both  of  words 
and  things,  were  obliterated  and  gone.  It  was  found 
necessary  for  her  to  learn  everything  again.  She  even 
acquired,  by  new  efforts,  the  art  of  spelling,  reading, 
writing,  and  calculating  ;  and  gradually  became 
acquainted  Avith  the  persons  and  objects  around,  like  a 
being  for  the  first  time  brought  into  the  world.  In 
these  exercises  she  made  considerable  proficiency.  But, 
after  a  few  months,  another  fit  of  somnolency  super- 
vened. On  rousing  from  it,  she  found  herself  restored 
to  the  state  she  was  in  before  the  first  paroxysm ;  but 
was  wholly  ignorant  of  every  event  and  occurrence  that 
had  befallen  her  afterward.  During  four  years  and 
upwards  she  has  passed  periodically  from  one  state  to 
the  other,  always  after  a  long  and  sound  sleep. 
The  former  condition  of  her  existence  she  now  calls 
the  Old  State,  and  the  latter  the  New  State;  and  she 
is  as  unconscious  of  her  double  character  as  two  dis- 
tinct persons  are  of  their  respective  natures.  For 
example,  in  her  old  state  she  possesses  all  the  original 
knowledge ;  in  her  new  state  only  what  she  acquired 
since.  If  a  lady  or  gentleman  be  introduced  to  her  in 
the  old  state,  or  vice  versa  (and  so  of  all  other  mat- 
ters), to  know  them  satisfactorily  she  must  learn  them 
in  both  states.  In  the  old  state,  she  possesses  fine 
powers  of  penmanship,  while  in  the  new,  she  writes  a 
poor,  awkward  hand,  not  having  had  time  or  means  to 
become  expert.  Both  the  lady  and  her  family  are  now 
capable  of  conducting  the  affair  without  embarrass- 
ment.    By  simply  knowing  whether  she  is  in  the  old 


208  INSOMNIA 

or  new  state,  they  regulate  the  intercourse,  and  govern 
themselves  accordingly." 

Another  remarkable  case  was  reported  at  length  by 
Dr.  Azam,  of  Bordeaux. '  The  principal  facts  are  given 
in  a  translation  by  Dr.  J.  I.  Tucker  in  the  Chicago 
Journal  of  Nervous  and  Menial  Disease.'^  The  patient 
was  a  young  woman  who  began  to  exhibit  the  symp- 
toms of  hysteria  at  the  age  of  puberty,  and  from  that 
time  till  the  present,  a  period  of  nearly  thirty  years, 
she  has  lived  a  double  life,  passing  alternately  from 
normal  life  into  somnambulic  life.  These  transitions 
were  ushered  in  by  a  sharp  pain  in  both  temples,  fol- 
lowed by  a  species  of  stupor,  lasting  about  ten  minutes. 
She  would  then  open  her  eyes,  apparently  awake,  and 
would  remain  in  the  condition  of  somnambulic  life  for 
an  hour  or  two,  when  the  languor  and  sleepiness  would 
reappear  for  a  few  minutes,  after  which  she  would 
awaken  in  her  normal  state.  At  fiiist  these  paroxysms 
were  renewed  every  five  or  six  hours ;  but,  as  she  grew 
older,  they  occurred  less  frequently,  and  were  greatly 
prolonged,  until,  finally,  the  periods  of  somnambulic 
life  considerably  exceeded  the  duration  of  normal  life. 
During  normal  life  she  was  hypochondriacal,  hysterical, 
and  a  sufferer  with  neuralgia.  During  somnambulic 
life  she  was  free  from  pain,  lively,  imaginative,  and 
coquettish.  While  in  this  state  of  existence  she 
remembered  the  events  of  her  entire  life — normal  or 
otherwise ;  but  on  returning  to  her  natural  mode  of  life, 
she  retained  no  recollection  of  her  somnambulic  periods. 

^ Revue  Scietitifique ,  May  20,  Sept.  i6,  1876;  Dec.  22,  1877;  March 
8,  1879. 

»  Vol.  Ill,  p.  584. 


SOMISrAMRULIC   LIFE.  209 

Memory,  during  normal  life,  was  limited  .to  anterior 
normal  periods.  As  time  advanced,  this  peculiar  mode 
of  existence  became  an  increasing  source  of  inconveni- 
ence and  mental  distress,  often  leading  tlie  superficial 
observer  to  suppose  that  she  was  insane. 

This  case  differs  from  the  others  in  the  circum- 
stance that  the  period  of  somnambulic  life  was  more 
vigorous  and  healthy  than  the  ordinary  condition.  This 
seems  to  suggest  an  explanation  of  the  forgetfulness 
which  marked  the  period  of  normal  life.  During  that 
period  the  functions  of  the  brain  were  depressed,  so 
that  its  molecular  movements  could  not  reach  the  level 
of  the  field  of  consciousness  occupied  during  the  second 
period.  Other  observations,  such  as  that  of  Sir  Henry 
Holland,^  who,  while  exhausted  by  fatigue,  lost  all 
recollection  of  the  German  language  until  he  was 
restored  by  rest  and  food,  indicate  that  such  defects  of 
memory  depend  upon  a  deficient  nutrition  of  the  brain 
substance — a  condition  which  is  undoubtedly  associated 
with  an  enfeebled  cerebral  circulation.  We  may,  there- 
fore, suppose  that  in  Dr.  Azam's  case  the  paroxysms  of 
somnambulic  life  were  induced  by  periodical  discharges 
of  force  within  the  brain,  causing  an  improvement  in 
the  circulation  of  blood,  and  a  corresponding  gain  in 
health  and  general  vivacity.  Such  exaltation  of  the 
faculties  would  be  perfectly  consistent  with  an  exercise 
of  memory  covering  all  the  events  of  life.  But,  when, 
as  in  cases  like  that  reported  by  Macnish,  and  by  my- 
self, somnambulic  life  is  the  result  either  of  disease  or 
simple  somnambulic  sleep,  it  is  a  condition  in  which, 
as  in  physiological  sleep,  the  cerebral  functions,  taken 

*  Chapters  on  Mental  Physiology,  p.  i6o. 
14 


210  INSOMNIA. 

as  a  whole,  are  depressed  rather  than  exalted.  The 
resulting  train  of  ideas  is  developed  upon  a  plane  below 
the  level  of  ordinary  consciousness,  and  is,  conse- 
quently, as  easily  forgotten  as  the  dreams  which  are 
developed  during  sleep. 

Such,  then,  are  the  principal  characteristics  of  som- 
nambulism— a  state  in  which  dreams  are  supplemented 
by  more  or  less  complete  and  appropriate  action;  ordi- 
narily without  subsequent  recollection  of  either  dream 
or  action.  The  somnambulic  dream  usually  occurs 
during  or  soon  after  the  period  of  deepest  sleep,  when 
the  influences  of  the  external  world  are  most  completely 
suppressed.  Released  from  the  control  of  its  sensory 
portion,  the  remainder  of  the  brain  awakens,  and 
becomes  aroused  to  a  condition  of  relative  exaltation. 
No  longer  distracted  by  the  solicitations  of  external 
sense,  the  attention  is  concentrated  upon  the  hallucina- 
tions which  constitute  the  dream.  In  the  simpler 
forms  of  noctambulism  only  the  automatic  locomotive 
apparatus  is  awakened,  and  the  sleeper  moves  in  accord- 
ance with  the  impressions  derived  from  habit,  aided  by 
actual  exaltation  of  the  muscular  and  tactile  senses. 
But,  in  some  of  the  more  complicated  cases,  a  certain 
amount  of  special  sensibility  seems  to  exist.  The 
patient  is  capable  of  exercising  just  that  amount  of 
perception  which  is  necessary  to  accomplish  his  pur- 
pose, though  blind  and  deaf  and  insensible  to  every 
other  impression.  The  more  complete  the  waking  of 
the  sense-organs,  the  closer  the  resemblance  to  the 
condition  of  ordinary  life,  or  even  to  the  condition  of 
ecstasy,  in  which  cerebral  exaltation  is  the  prominent 
feature,  and  in  which   the   power   of  recollection  gen- 


SOMNAMBULISM.  211 

erally  persists.  Accordingly,  it  sometimes  happens 
that  the  somnambulist  can  recall  the  events  of  his 
paroxysm.  In  such  cases  the  power  of  recollection  is 
due  to  the  same  conditions  that  control  the  recollection 
of  our  ordinary  dreams.  But  the  phenomena  of  ordi- 
nary somnambulism  are  as  completely  as  possible 
removed  from  all  connection  with  the  mental  actions 
which  arise  directly  from  the  operation  of  the  senses. 
By  reason  of  such  isolation  the  ordinary  association  of 
ideas  affords  no  help  to  the  memory,  and  the  dream 
remains  in  oblivion,  Alfred  Maury  expresses  the 
opinion  ^  that  the  principal  cause  of  f orgetf  ulness  of  the 
events  of  somnambulism  consists  in  the  exhaustion  of 
the  cerebral  elements  through  the  intensity  of  the 
excitement  to  which  they  have  been  subjected  during 
the  paroxysm.  Doubtless  this,  in  certain  cases,  may 
contribute  to  the  loss  of  memory,  but  it  should  be 
remembered  that  the  excitement  may  be  relative  rather 
than  absolute.  Certain  elements  wake  while  others  are 
asleep;  and  these  waking  cells  may  be  aroused  to  a 
degree  far  in  excess  of  what  is  usual  during  the  sleep 
of  the  brain  without  attaining  to  the  level  of  their 
diurnal  activity.  The  mind,  undisturbed  by  external 
impressions,  gives  its  attention  to  the  operation  of 
these  waking  organs,  -and  a  dream  with  all  its  conse- 
quences, somnambulic  or  otherwise,  is  the  result.  In 
other  words,  the  plane  of  consciousness,  so  to  speak,  is 
lowered  in  sleep  to  the  level  of  these  molecular  vibra- 
tions. But  when  the  entire  brain  has  been  completely 
reawakened,  the  residual  vibrations  of  those  elements 
which  yielded  the  physical  basis  of  the  dream,  and 

^  Le  Sommeil  et  ks  Reves,  p.  226. 


212  INSOMNIA. 

which,  had  they  originally  occurred  during  the  waking 
state,  might   have   persisted  with   energy  sufficient  to 
furnish   a   groundwork    for   recollection   of    the   ideas 
which  they  had  first  suggested,  are  no  longer  sufficiently 
forcible  to  be  felt  in  consciousness.     Recollection   of 
mental    states    thus    generated    must    necessarily   be 
impossible  under  such   conditions.      Sometimes,   how- 
ever, the  somnambulist  who,  while  awake,  had  forgot- 
ten all  the  incidents  of  his  somnambulic  experience, 
can   remember,  in    a    subsequent    paroxysm,   all    that 
occurred  during  the  preceding  attack.     Facts  of  this 
kind  have  been  observed  in  the  waking  life  of  certain 
hysterical  persons,  but  the  apparent  doubling  of  their 
personality  is  connected  with  the  waking  state,  or  with 
its  semblance,  while  in  ordinary  somnambulism  it  is 
only  during  sleep  that  the  alternations  of  memory  and 
forgetfulness  occur.     A  similar  recollection  of  previous 
visions  is  sometimes  experienced  in  dreams,  showing  a 
close  relationship  between  the  dreams  of  sleep  and  of 
somnambulism.     The    bond    of    association    between 
events    thus    isolated    in    time   must   be   sought   in  a 
renewal  of  like  conditions  of  the  brain  during  the  suc- 
cessive periods  of  somnambulic  exaltation.     We  must 
suppose  that  the  molecules  which  were  in   a  state  of 
excitement  during  the  first  paroxysm  are  again  aroused 
in  a  similar   manner  after  a  period   of  waking   quies- 
cence.    If,  during  sleep,  their  movements,   though  of 
an  exalted  character,  have  only  just  sufficed  to  arouse 
consciousness   in   the   form   of   a  dream,  it  is  scarcely 
probable   that  during  the  phase  of  comparative  inac- 
tivity which  supervenes  when  the  whole  brain  is  awake, 
their  residual  motion  could  disturb  the  sphere  of  con- 


SOMNAMBULISM.  213 

sciousness.  Hence  the  time  occupied  by  their  som- 
nambulic vigor  must  remain  a  blank  in  memory  during 
the  waking  state.  But,  when  the  original  state  of 
relative  exaltation  has  been  reproduced  by  a  second 
paroxysm  of  disorder,  if  the  same  molecular  move- 
ments be  in  any  way  renewed,  the  conditions  of 
memory  are  fulfilled;  consciousness  is  once  more 
aroused  as  before,  and  the  patient  remembers  the 
dream  or  the  events  of  the  previous  attack. 


CHAPTEK  VII. 

ARTIFICIAL    SOMNAMBULISM    OR    HYPNOTISM. 

There  are  more  things  in  heaven  and  earth,  Horatio, 
Than  are  dreamt  of  in  your  philosophy. 

— Hamlet. 

The  phenomena  of  somnambulism  are  of  apparently 
spontaneous  origin,  during  ordinary  sleep.  But  from 
the  remotest  antiquity  it  has  been  known  that  certain 
persons  may  be  thrown  into  an  artificial  sleep  which 
closely  resembles  the  condition  of  the  somnambulist. 
Such  a  degree  of  susceptibility  is  not  common  to  all 
persons.  Heidenhain,  experimenting  upon  his  class  of 
medical  students,  found  only  one  in  twelve  who  was 
thus  susceptible.  My  own  experiments  lead  me  to 
think  that  American  medical  students  are  less  easily 
influenced  in  this  direction.  Charcot,  whose  field  of 
observation  covers  the  inmates  of  the  Salpetri^re  Hos- 
pital, finds  the  best  examples  of  the  hypnotic  state 
among  the  hystero- epileptic  females  in  that  asylum. 
To  the  experiments  of  Heidenhain,  in  Germany,  of 
Braid,  in  England,  and  of  Charcot,  in  France,  we  are 
indebted  for  the  most  thoroughly  scientific  observation 
and  interpretation  of  the  phenomena  of  hypnotism. 

The  antecedent  physical  condition  most  favorable  to 
the  development  of  the  hypnotic  state  is  a  highly 
unstable  constitution  of  the  nervous  system.     For  this 

(214) 


HYPNOTISM.  215 

reason  the  larger  number  of  qualified  subjects  is 
furnished  by  the  female  sex — especially  by  those  who 
possess  the  hysterical  temperament.  Frequent  repeti- 
tion of  hypnotic  exercises  renders  the  subject  still 
more  susceptible.  Heidenhain  was,  at  first,  inclined 
to  the  belief  that  such  experiences  were  not  prejudicial 
to  the  health  of  the  subject,  but  the  observations  of 
Harting,  in  the  University  of  Utrecht,  and  of  Milne- 
Edwards,  in  Paris,  ^  have  demonstrated  the  fact  of 
danger  to  the  health  of  animals  subjected  to  similar 
experiments.  Hysterical  patients  have  often  exhibited 
considerable  exhaustion  after  hypnotic  exhibition  in 
the  Ifospitals  of  Paris  (Charcot  and  Richer),  conse- 
quently, it  cannot  be  admitted  that  the  practice  is 
devoid  of  risk  to  the  health  of  the  individual. 

Numerous  methods  of  inducing  the  hypnotic  state 
have  been  employed.  The  greater  number  consist  in 
artificial  modification  of  the  condition  of  the  l^rain 
through  the  agency  of  sensory  impressions  originated 
upon  the  periphery  of  the  body.  The  simplest  form 
of  such  influence  is  presented  by  the  results  of  gentle 
friction  of  the  skin  with  the  palm  of  the  hand  or  the 
tips  of  the  fingers.  Many  an  aching  head  has  thus 
been  relieved,  many  a  restless  sufferer  soothed  to  sleep. 
In  like  manner,  a  susceptible  subject  may  be  hyp- 
notized by  any  continuous  and  gentle  excitement  of  the 
senses  of  sight,  hearing,  and  touch.  Concentration  of 
the  attention  upon  a  brilliant  object,  like  a  piece  of 
polished  metal  or  a  small  mirror,  especially  if  it  be 
placed  a  little  above  the  level  of  the  eyes,  and  so  near 
that  considerable  convergence  of  the  eyeballs  is  neces- 

"^  Lancet,  July  29,  1882,  p.   164. 


216  INSOMNIA. 

sarj  for  distinct  vision,  affords  a  very  efficient  means 
of  inducing  artificial  somnambulism.  Certain  persons 
may  be  readily  hypnotized  by  gently  pressing  the  eye- 
lids together,  and  at  the  same  time  making  slight 
pressure  upon  the  eyeballs.  Others  pass  into  this 
condition  by  merely  closing  their  eyes,  and  remaining 
motionless  in  a  quiet  room. 

The  phenomena  of  artificial  somnambulism  are 
frequently  developed  through  the  agency  of  impres- 
sions derived  directly  from  the  sphere  of  conscious- 
ness. The  intellectual  effort  of  trying  to  sit  still  and 
think  of  nothing  is  sometimes  sufficient  to  induce  the 
hypnotic  state.  The  ordinary  devices  by  means  of 
which  wakeful  people  are  taught  to  beguile  sleep,  by 
counting,  or  by  repeating  long  lists  of  names,  etc.,  all 
belong  to  this  category.  Compulsory  attention  to  any 
continuous  intellectual  process,  like  adding  up  a  col- 
umn of  figures,  or  trying  to  read  a  dull  book,  is  some- 
times effectual.  If,  with  these,  or  with  similar  acts  of 
attention,  be  associated  the  expectation  that  something 
unusual  is  about  to  occur,  as  when  the  individual  is 
aware  of  being  the  subject  of  an  experiment,  the  evolu- 
tion of  the  somnambulic  condition  is  greatly  facilitated. 
Thus,  one  of  the  most  recent  methods,  consists  in 
merely  sitting,  for  half  an  hour  or  more,  with  the  back 
towards  the  patient.  Attention,  curiosity,  and  expecta- 
tion, are  thus  excited,  and  a  susceptible  person  soon 
begins  to  manifest  some  of  the  numerous  and  various 
forms  of  the  hypnotic  state.  Heidenhain  caused  one  of 
his  students  thus  to  go  to  sleep  in  broad  daylight,  by 
simply  assuring  him  that  he  should  hypnotize  him  from 
a  distance  at  a  particular  hour  of  the  afternoon.      The 


HYPNOTISM.  217 

monks  of  Mi  Athos  were  accustomed  to  hypnotize 
themselves  by  fixing  their  eyes  and  their  thoughts  upon 
the  navel ;  hence  the  reputation  of  omphaloscopy  as  an 
aid  to  ecstatic  meditation. 

The  duration  of  hypnotic  sleep  is  as  variable  as  that 
of  its  prototype  in  natural  somnambulism.  The  patient 
usually  wakes  spontaneously,  after  a  few  minutes  or 
hours.  Sometimes,  however,  the  period  of  insensibility 
is  greatly  prolonged.  If  it  be  desirable  to  awaken  the 
subject  of  experiment,  a  simple  reversal  of  the  move- 
ments by  which  sleep  was  induced  may  suffice.  The 
paroxysm  may  be  terminated  by  almost  any  sudden 
and  energetic  appeal  to  the  senses,  like  an  electric 
shock,  a  sudden  illumination  of  the  eye  with  vivid 
light,  or  a  sharp  pufP  of  air  upon  the  face. 

The  simplest  phenomena  connected  with  the  hyp- 
notic state  are  those  transferences  of  cerebral  percep- 
tions which  have  been  investigated  by  the  Society  for 
Psychical  Research.^  Certain  sensitive  persons,  when 
blindfolded,  are  capable  of  reproducing  with  consider- 
able accuracy  visual  images  that  have  been  impressed 
upon  the  mind  of  another.  The  sensitive  subject  is 
blindfolded  and  placed  before  a  table  with  pencil  and 
paper.  Another  person  then  goes  out  of  the  room, 
and  gazes  at  some  kind  of  drawing,  geometrical  figure, 
or  other  object  selected  without  possibility  of  collusion 
with  the  subject  of  experiment.  This  person  then 
returns  to  the  room,  and  places  his  hand  upon  the  head 
of  the  subject,  at  the  same  time  fixing  his  attention 
upon  the  mental  picture  of  the  object.  Presently  the 
blindfolded  subject  takes  the  pencil  and  reproduces  on 

*  Transactions  of  the  Society,  etc.,  Vols.   I,  II,  III. 


218  INSOMNIA. 

paper  a  rough  drawing  of  the  object  in  question.  In 
some  cases  it  is  found  possible  to  effect  this  transfer  of 
impressions  without  actual  physical  contact, — the  agent 
merely  standing  behind  the  sensitive  subject  and  con- 
centrating his  thought  upon  the  selected  object. 
Closely  akin  to  this  is  the  method  of  muscle-reading, 
popularly  known  as  mind-reading.  The  sensitive  is 
blindfolded,  and  then  presses  against  his  forehead  the 
hand  of  the  person  by  whom  he  is  to  be  guided. 
Almost  immediately  a  tremor  pervades  his  muscles, 
and  he  yields  all  his  movements  to  the  guiding  influ- 
ence of  the  individual  with  whom  he  is  in  contact.  If 
now  an  object  be  concealed  in  any  place  that  is  known 
to  the  agent,  the  concentration  of  that  person's  atten- 
tion upon  the  hiding  place  suffices  to  direct  the  "  mind- 
reader,"  who  immediately  drags  his  companion  to  the 
given  locality. 

The  explanation  of  these  phenomena  consists  in  a 
recognition  of  the  fact  that  certain  persons  are  gifted 
with  nervous  organs  which  are  sensitive  and  responsive 
to  nervous  impulses  and  muscular  movements  that  are 
too  delicate  for  recognition  by  the  percipient  appa- 
ratus of  ordinary  mankind.  The  more  complicated 
forms  of  artificial  somnambulism  result  from  the  com- 
plication and  exaggeration  of  the  results  of  this  inor- 
dinate sensitiveness  through  the  agency  of  artificial 
sleep.  As  in  natural  somnambulism,  so  in  the  hyp- 
notic state,  certain  organs  become  totally  anaesthetic, 
while  the  sensibility  of  others  is  wonderfully  exalted. 
Cutaneous  sensation  may  be  completely  abolished,  and 
the  patient  may  become  utterly  insensible  to  every 
painful    impression.     The    reflex    functions    may    be 


HYPNOTISM.  219 

either  suppressed  or  exaggerated,  and  the  special 
senses  of  sight  and  hearing  may  be  exalted  to  the 
highest  degree.  While  in  this  condition  the  hyperses- 
thetic  condition  of  the  brain  renders  the  subject  pecul- 
iarly susceptible  to  impressions  from  the  will  of 
another,  so  that  all  his  actions  are  obedient  to  the 
guiding  influence  of  the  person  under  whose  control 
he  has  passed. 

According  to  Charcot,^  three  principal  types  of  arti- 
ficial somnambulism  may  be  remarked  among  the 
hysterical  subjects  upon  whom  he  experimented:  (1) 
th.Q  cataleptic,  (2)  the  lethargic,  and  (3)  the  somnam- 
hulic.  Of  these  the  first  may  be  developed  primarily 
by  any  abrupt  and  powerful  impression  upon  a  sensory 
organ.  Gazing  upon  a  brilliant  light,  fixing  the  eyes 
upon  a  piece  of  polished  metal,  or  upon  the  shining 
eyes  of  a  second  person,  the  sudden  clangor  of  a  Chi- 
nese gong,  may  suffice  to  induce  the  cataleptic  state. 
Dumontpallier^  reports  the  case  of  a  young  woman  who 
accidentally  hypnotized  herself  by  gazing  into  the 
mirror  before  which  she  was  dressing  her  hair.  This 
cataleptic  state  may  also  be  secondarily  induced  by 
merely  opening  the  eyes  of  a  patient  in  whom  a  condi- 
tion of  hypnotic  lethargy  has  been  previously  devel- 
oped. If  only  one  eye  be  thus  opened,  the  correspond- 
ing side  of  the  body  alone  becomes  cataleptic.  Closing 
the  eyes  causes  the  disappearance  of  this  symptom, 
with  complete  restoration  of  the  purely  lethargic  state. 
During  the  cataleptic  condition  the  several  tendinous 
reflexes   disappear,  neuro-muscular  hyper-excitability 

^  Le  Progrh  MMical,  Feb.  i8,  1882,  p.  124. 
'^  Le  Progres  Medical,  March  25,  1882,  p.  223. 


220  INSOMNIA. 

ceases,  the  skin  becomes  insensible,  but  tlie  special 
senses,  particularly  those  of  sight  and  hearing,  main- 
tain a  partial  activity.  In  this  half-awakened  state  the 
senses  may  become  avenues  of  suggestion  from  without 
for  the  production  of  movements ;  but,  if  left  to  them- 
selves, the  limbs  remain  motionless. 

The  lethargic  state  may  be  induced  by  simply  press- 
ing together  the  eyelids  of  the  subject,  or  by  causing 
him  to  fix  his  gaze  upon  some  definite  object.  The 
paroxysm  begins  with  a  deep  inspiration,  causing  a 
peculiar  laryngeal  sound,  followed  sometimes  by  the 
appearance  of  a  little  foam  on  the  lips.  The  eyelids 
are  either  wholly  or  partially  closed,  and  are  in  a  state 
of  continual  tremulous  motion.  The  eyeballs  are 
generally  turned  upwards  and  inwards.  The  muscles 
are  completely  relaxed.  The  tendinous  reflexes  are 
exaggerated;  pressure  over  a  muscle,  or  upon  a  nerve, 
arouses  a  peculiar  contracture  of  synergic  muscles  and 
groups  of  muscles  that  are  supplied  by  the  excited 
nerve  trunk.  The  facial  muscles,  however,  do  not  thus 
become  contractured ;  they  merely  contract  during  the 
application  of  the  stimulus.  If  the  lethargic  subject 
be  rendered  cataleptic  by  opening  the  eyes,  these  con- 
tractures persist  even  after  waking ;  and  they  can  only 
be  dispelled  by  renewing  the  lethargic  state  before 
resorting  to  pressure  upon  the  antagonistic  muscles — 
the  process  by  which  contractures  peculiar  to  this  spe- 
cies of  lethargy  may  always  be  annulled.  By  the 
approach  of  a  magnet  to  a  contractured  limb,  the 
rigidity  may  be  completely  transferred  to  the  corre- 
sponding muscles  upon  the  opposite  side  of  the  body.  If 
upon  a  limb  of  a  lethargic   subject  who  has  been  ren- 


HYPNOTISM  221 

dered  cataleptic  by  opening  the  eyes,  an  Esmarch's 
band  be  applied,  pressure  over  the  bloodless  muscles 
excites  no  contracture  until  the  band  is  removed.  A 
contracture  is  then  developed,  and  it  may  be  trans- 
ferred to  the  opposite  limb  by  the  approach  of  a 
magnet.  To  this  phenomenon  has  been  applied  the  term 
latent  contracture. 

The  extraordinary  muscular  excitability  manifested 
by  these  subjects  is  further  illustrated  by  an  observa- 
tion recorded  by  Dumontpallier.^  If  one  end  of  an 
India  rubber  tube,  half  an  inch  in  diameter,  and  five 
or  six  yards  in  length,  be  applied  over  a  muscle  in  the 
leg,  and  if  the  other  end  be  in  like  manner  connected 
with  a  watch,  every  movement  of  the  second  hand  will 
be  followed  by  a  slight  contraction  in  the  muscle.  The 
same  result  follows  connection  with  the  wire  of  a  tele- 
phone; and,  if  a  microphone  be  introduced  into  the 
circuit,  the  incidence  of  a  ray  of  light  upon  the  instru- 
ment, or  even  its  reflection  from  the  conjunctival 
surface  of  the  eye  of  a  spectator,  will  arouse  a  respon- 
sive muscular  contraction.  Charcot  has  also  seen  mus- 
cular motion  upon  the  opposite  side  of  the  body  when 
a  mild  galvanic  current  was  applied  to  the  parietal 
surface  of  the  skull,  presumably  over  the  motor  centres 
of  the  corresponding  half  of  the  brain. 

During  these  manifestations  of  muscular  hyper- 
excitability,  there  is  complete  insensibility  to  pain,  but 
the  senses  of  sight  and  hearing  seem  to  preserve  some 
degree  of  activity.  The  subject,  however,  does  not 
often  exhibit  any  susceptibility  to  influence  by  sug- 
gestion. 

^  Le  Progres  Medical,  Jan.  14,  1882,  p.  25. 


222  INSOMNIA. 

The  somnambulic  states  may  be  directly  induced  by 
fixed  attention  with  the  eyes,  by  feeble  and  monoto- 
nous excitement  of  the  senses,  by  passing  the  hands 
over  the  face  and  arms  of  the  subject,  and  by  many 
other  processes  of  analogous  character.  This  variety 
constitutes  the  ordinary  form  of  hypnotic  sleep.  It 
may  be  very  easily  developed  during  either  the  leth- 
argic or  the  cataleptic  state  as  a  consequence  of 
pressure  or  of  gentle  friction  upon  the  top  of  the 
head.  Thus  Heidenhain,  in  the  course  of  his  experi- 
ments, caused  muscular  paralysis  by  rubbing  the  scalp. 
Friction  of  one  side  of  the  head  occasioned  paralysis 
of  the  opposite  side  of  the  body  without  notable  affec- 
tion of  the  consciousness  of  the  subject.  The  eyes  and 
the  eyelids  behave  as  in  the  lethargic  state.  The  sub- 
ject seems  to  be  asleep,  but  there  is  less  muscular 
relaxation  than  in  the  lethargic  variety.  There  is  no 
exaggeration  of  the  tendinous  reflexes,  and  muscular 
hyper-excitability  is  absent.  But  by  lightly  touching 
or  breathing  upon  the  surface  of  a  limb,  its  muscles 
may  be  thrown  into  a  condition  of  rigidity  which 
differs  from  the  contracture  of  the  lethargic  state,  in 
the  fact  that  it  does  not  yield  to  excitement  of  the 
antagonistic  muscles,  though  yielding  readily  to  a 
sudden  repetition  of  the  same  form  of  excitement  by 
which  it  was  originally  produced.  Thus  a  subject 
under  my  own  observation  who,  by  pressure  upon  the 
eyeballs,  was  rendered  insensible  to  every  form  of 
painful  stimulation,  would  immediately  pass  into  .a 
state  of  perfect  rigidity,  if  his  limbs  and  body  were 
rubbed  for  a  few  seconds  with  the  palm  of  the  hand. 
While  in  this  condition,  if  the  heels  were  placed  upon 


HYPNOTISM.  223 

a  chair  and  tlie  back  of  the  head  upon  another,  not 
only  could  the  entire  weight  of  the  body  be  thus  sup- 
ported, but  also  the  additional  weight  of  another  full- 
grown  man,  sitting  upon  his  body,  without  causing  any 
more  yielding  than  if  it  had  been  a  log  of  wood  that 
was  lying  across  the  chairs.  From  the  immobility  of 
the  cataleptic  state  this  rigidity  differs  by  its  greater 
degree  of  resistance  to  passive  motion.  Though  insen- 
sibility to  pain  may  be  perfectly  developed  in  this  state, 
there  is  generally  an  exalted  condition  of  certain  forms 
of  cutaneous  sensibility,  and  of  the  muscular  sense. 
Strange  perversions  of  other  special  senses  are  some- 
times remarked.  Thus,  Cohn'  discovered  that  a  patient 
who  was  naturally  color-blind,  was  able,  when  unilat- 
erally hypnotized,  "to  distinguish  colors  which  were 
otherwise  undistinguishable."  Conversely,  when  the 
cataleptic  state  is  induced,  the  healthy  eye  becomes 
incapable  of  discerning  colors.  Spasm  of  accommoda- 
tion is  also  present,  and  is  one  of  the  earliest  demon- 
strable symptoms  of  the  hypnotic  condition. 

These  remarkable  exaggerations  and  perversions  of 
sensibility  have  been  the  cause  on  the  one  hand,  of 
much  skepticism  regarding  the  verity  of  the  phe- 
nomena of  hypnotism,  and,  on  the  other,  of  much 
credulity,  extending  even  to  a  belief  in  the  existence 
of  supernatural  and  miraculous  powers.  The  extra- 
ordinary character  of  these  experiences  is  well  illus- 
trated by  the  following  letter  from  Lieut.  J.  M.  Brooke, 
of  the  United  States  Navy,  to  President  Wayland,  of 
Brown  University.  It  may  be  found  in  "Way land's 
Intellectual  Philosophy. ' ' 

^  Brain,  Vol.  Ill,  p.  394. 


224  INSOMNIA. 

"  Washington,  Oct.  27th,  1851. 

"Sir — It  affords  me  pleasure  to  comply  with  your  request,  made 
through  my  brother  William,  relative  to  some  experiments  performed  on 
board  the  United  States  steamer  '  Princeton,'  in  the  latter  part  of  the 
year  1847,  she  being  then  on  a  cruise  in  the  Mediterranean.  Nathaniel 
Bishop,  the  subject  of  the  experiments,  was  a  mulatto,  about  twenty-six 
years  of  age,  in  good  health,  but  of  an  excitable  disposition.  The  first 
experiment  was  of  the  magnetic  or  mesmeric  sleep,  which  overpowered 
him  in  thirty  minutes  from  the  commencement  of  the  passes  made  in  the 
ordinary  way,  accompanied  with  a  steadfast  gaze  and  effort  of  the  will 
that  he  should  sleep. 

"In  this  state  he  was  insensible  to  all  voices  but  mine,  unless  I 
directed  or  willed  him  to  hear  others;  he  was  also  insensible  to  such 
amount  of  pain  as  one  might  inflict  without  injury,  that  is,  what  would  have 
been  pain  to  another.  He  would  obey  my  directions  to  whistle,  dance  or 
sing.  When  aroused  from  this  sleep  he  had  no  recollection  of  what 
occurred  while  in  it.  That  such  an  influence  could  be  exerted,  I  was 
already  aware,  having  previously  witnessed  satisfactory  experiments.  Of 
clairvoyance  I  had  never  been  convinced;  indeed,  considered  it  nothing 
but  a  sort  of  dreaming  produced  by  the  will  of  the  operator.  I  became 
aware  of  its  truth  rather  through  accident  than  design. 

"  It  happened,  one  day,  that  some  of  my  brother  officers  asked  a 
question  which  the  others  could  not  answer.  Bishop,  who  had  been  a 
few  moments  before  in  a  mesmeric  sleep,  gave  the  desired  information, 
speaking  with  confidence  and  apparent  accuracy.  As  the  information 
related  to  something  which  it  seemed  almost  impossible  to  know  without 
seeing,  we  were  very  much  surprised.  It  struck  me  that  he  might  be 
clairvoyant;  and  I  at  once  asked  him  to  tell  me  the  time  by  a  watch  kept 
in  the  binnacle,  on  the  spar  or  upper  deck,  we  being  on  the  berth  or  lower 
deck.  He  answered  correctly,  as  I  found  upon  looking  at  the  watch, 
allowing  eight  or  nine  seconds  for  time  occupied  in  getting  on  deck.  I 
then  asked  him  many  questions  with  regard  to  objects  at  a  distance, 
which  he  answered,  and,  as  far  as  I  could  ascertain,  correctly. 

**  For  example,  one  evening,  while  at  anchor  in  the  port  of  Genoa, 
the  captain  was  on  shore.  I  asked  Bishop,  in  the  presence  of  several 
officers,  where  the  captain  then  was.  He  replied,  '  At  the  opera  with 
Mr.  Lester,  the  consul.'  'What  does  he  say?'  I  inquired.  Bishop 
appeared  to  listen,  and  in  a  moment  replied:  *  The  captain  tells  Mr. 
Lester  that  he  was  much  pleased  with  the  port  of  Xavia;  that  the  authori- 
ties treated  him  with  much  consideration.'  Upon  this,  one  of  the  officers 
laughed,  and  said  that  when  the  captain  returned  he  would  ask  him.  He 
did  so,  saying,  '  Captain,  we  have  been  listening  to  your  conversation 


HYPNOTISM.  225 

while  on  shore.'  'Very  well,'  remarked  the  captain,  'what  did  I  say?' 
expecting  some  jest.  Then  the  officer  repeated  what  the  captain  had  said 
of  Xavia  and  its  authorities.  '  Ah,'  said  the  captain,  '  who  was  at  the 
opera?  I  did  not  see  any  of  the  officers  there.'  The  lieutenant  then 
explained  the  matter.  The  captain  confirmed  its  truth,  and  seemed  much 
surprised,  as  there  had  been  no  other  communication  with  the  shore  dur- 
ing the  evening.  I  may  remark  that  we  touched  at  several  ports  between 
Xavia  and  Genoa. 

"  On  another  occasion,  an  officer  being  on  shore,  I  directed  Bishop 
to  examine  his  pockets;  he  made  several  motions  with  his  hands,  as  if 
actually  drawing  something  from  the  officer's  pockets,  saying,  '  Here  is  a 
handkerchief  and  a  box;  what  a  curious  thing!  full  of  little  white  sticks 
with  blue  ends.  What  are  they,  Mr.  Brooke?  '  I  replied,  '  Perhaps  they 
are  matches.'  '  So  they  are,'  he  exclaimed.  My  companion,  expecting 
the  officer  mentioned,  went  on  deck,  and  meeting  him  at  the  gangway, 
asked,  '  What  have  you  in  your  pockets?  '  '  Nothing,'  he  replied.  'But 
have  you  not  a  box  of  matches?  '  '  Oh,  yes' '  said  he.  *  How  did  you 
know  it?  I  bought  them  just  before  I  came  on  board.  The  matches 
are  peculiar,  made  of  white -wax  with  blue  ends.' 

"  The  surgeons  of  the  '  Princeton '  ridiculed  these  experiments,  upon 
which  I  requested  one  of  them  (Farquharson)  to  test  for  himself,  which 
he  consented  to  do.  With  some  care  he  placed  Bishop  and  myself  in  one 
coTner  of  the  apartment,  and  then  took  a  position  some  ten  feet  distant, 
concealing  between  his  hands  a  watch,  the  long  hand  of  which  traversed 
the  dial.  He  first  asked  for  a  description  of  the  watch.  To  which 
Bishop  replied,  '  'Tis  a  funny  watch,  the  second  hand  jumps.' 

"  The  doctor  then  asked  him  to  tell  the  minute  and  second,  which 
he  did;  directly  afterwards  exclaiming,  '  The  second  hand  has  stopped! ' 
which  was  the  case,  Dr.  Farquharson  having  stopped  it.  '  Well,'  said 
the  doctor,  '  to  what  second  does  it  point,  and  to  what  hour,  and  what 
minute  is  it  now? '  Bishop  answered  correctly,  adding,  '  'Tis  going 
again.'     He  then  told  twice  in  succession  the  minute  and  second. 

"  The  doctor  was  convinced,  saying  that  it  was  contrary  to  reason, 
but  he  must  believe.  I  then  proposed  that  the  doctor  should  mark;  and 
directed  Bishop  to  look  in  his  mother's  house,  in  Lancaster,  Pa.,  (where 
he  had  never  been)  for  a  clock;  he  said  there  was  one,  and  told  the  time 
by  it;  one  of  the  officers  calculated  the  difference  in  time  for  the  longi- 
tudes of  Lancaster  and  Genoa,  and  the  clock  was  found  to  agree  within 
five  minutes  of  the  watch  time." 

Such  clairvoyance  is  very  rare ;  in  fact,  it  is  difficult, 
at  first  thought,  to  believe  in  its  existence.      Nor  should 
15 


226  INSOMNIA. 

its  alleged  possession  be  credited  in  any  instance  until 
all  possibility  of  deception  has  been  excluded.  The 
example  just  related  seems  to  be,  in  this  respect,  one 
of  the  best,  for  the  reason  of  its  occurrence  in  a  little 
group  of  men  whose  isolation  and  thorough  acquaint- 
ance with  each  other  must  have  reduced  the  chances  of 
simulation  to  the  lowest  degree.  When  carefully  con- 
sidered, moreover,  it  is  apparent  that  the  exaltation  of 
the  functions  of  sight  and  of  hearing  in  this  case  was 
not  different  in  kind  or  in  degree  from  that  that  has 
already  been  recorded  in  connection  with  certain  cases 
of  natural  somnambulism  and  of  dreaming.  The  con- 
dition of  the  brain  is  probably  identical  in  all  such 
instances;  it  is  the  mode  of  its  induction  that  is  subject 
to  variation.  The  remarkable  feature  of  the  hypnotic 
state  consists  in  its  production  at  the  pleasure  of  either 
the  subject  or  of  the  agent  under  whose  control  he  has 
passed;  whereas  the  phenomena  of  natural  somnam- 
bulism and  of  the  clairvoyant  dream  occur  only  during 
sleep,  and  independently  of  the  will  of  the  patient. 

Another  singular  fact  in  this  connection  is  the 
receptivity  of  the  hypnotized  brain  for  suggestions 
from  the  minds  of  other  persons.  Usually,  the  patient 
is  insensible  to  all  communications  which  do  not 
emanate  from  the  agent  by  whom  he  is  held  in  control ; 
but  in  certain  cases  it  is  probable  that  the  brain  is 
more  or  less  open  to  impressions  of  a  particular  sort 
from  any  source.  Numerous  examples  illustrate  the 
manner  in  which  the  course  of  an  ordinary  dream  may 
be  thus  directed.  The  hypnotic  dream  is  far  more 
easily  modified  by  suggestions  from  without.  The 
simplest  examples  of  this  are  exhibited  by  the  hypno- 


HYPNOTISM.  227 

tized  subject  who  walks,  jumps,  lies  down,  executes 
every  variety  of  pantomime,  in  obedience  to  the  com- 
mands of  his  director.  Somewhat  more  complicated 
are  the  actions  that  are  developed  through  excitement 
of  the  imitative  faculties.  Every  movement  of  the 
director  ihat  can  he  perceived  by  the  subject  will  be  at 
once  rejoroduced.  Dr.  Fischer  relates  ^  the  case  of  a 
patient  who,  although  exceedingly  ignorant  of  the  art 
of  music,  was  able,  during  the  hypnotic  paroxysm,  to 
sing  with  Jenny  Lind  all  kinds  of  songs,  so  accurately 
that  it  was  impossible  to  distinguish  their  separate 
voices.  Expression  of  the  various  emotions  and  pas- 
sions may  also  be  provoked  by  merely  placing  the 
subject  in  the  several  attitudes  characteristic  of  such 
feelings. 

In  the  lower  grades  of  the  hypnotic  state,  con- 
sciousness is  not  abolished,  and  the  subsequent  recol- 
lection of  events  during  the  experience  may  be  quite 
perfect.  In  such  cases  illusions  and  hallucinations,  that 
were  excited  by  suggestions  from  the  controlling  mind 
of  another,  survive  in  memory,  and  become  the  causes 
of  serious  delusion.  Witness,  for  example,  the  manner 
in  which  excitable  people,  partially  hypnotized  in  a  so- 
called  "  spiritual  circle."  believe  in  the  reality  of  the 
illusions  which  have  occupied  their  powers  of  percep- 
tion during  a  "seance."  To  this  inferior  grade  of  self- 
induced  hypnotism  belong  all  those  conditions  of 
sensory  hypersesthesia  by  means  of  which  certain  per- 
sons are  enabled  to  read  the  hidden  thoughts  of  others. 
This  capacity  is,  essentially,  a  mere  exaltation  of  that 
power  which  all  mankind  shares  in  a  greater  or  less 

^  op.  cit.,  p.  1 8. 


228  INSOMNIA. 

degree.  In  every  instance  it  has  been  remarked  that 
the  ordinary  "medium"  can  only  respond  correctly  to 
questions  for  which  the  true  answer  is  present  in  the 
mind  of  the  questioner.  To  all  other  interrogatories 
the  replies  are  delivered  purely  under  the  influence  of 
random  suggestion.  In  some  cases  the  pathway  of 
communication  lies  through  actual  bodily  contact,  as 
in  ordinary  "  mind-reading,"  where  the  invisible 
molecular  oscillations  of  the  muscular  elements  of  one 
person  serve  to  guide  the  perceptions  and  movements 
of  another.  But,  more  frequently,  the  transmission  of 
ideas  is  effected  through  the  action  of  the  facial  and 
ocular  muscles.  From  these  organs  of  expression  the 
"table-rapper,"  or  the  "planchette-writer,"  reads  the 
unspoken  thoughts  of  the  questioner,  in  a  manner  very 
like,  yet  vastly  more  delicate  than  that  by  which  deaf 
mutes  are  taught  to  interpret  the  movements  of  the  lips 
of  persons  with  whom  they  converse.  This  fact  is 
clearly  illustrated  by  the  experience  of  Maury,'  in  an 
interview  with  a  celebrated  table-rapper  who,  without 
the  slightest  hesitation,  made  known  to  him  the  age, 
name,  and  date  of  death  of  a  brother  whom  he  had 
lost.  She  also  gave  the  same  information  regarding 
his  father,  and  pronounced  the  names  of  other  persons 
upon  whom  he  had  fixed  his  attention.  But,  if  he 
turned  away  his  face,  or  if  he  concealed  his  eyes  so 
that  the  woman  could  no  longer  scrutinize  their  expres- 
sion, her  responses  became  entirely  uncertain  and 
destitute  of  conformity  witli  fact. 

The  induction  of  the  hypnotic  state,  if  not  too  often 
repeated,  is  sometimes  of  considerable  service  in  the 

'  Le  Sommeil  et  les  Reves,  p.  361. 


HYPNOTISM.  229 

relief  of  various  functional  disorders  of  a  painful 
character.  This  fact,  enthusiastically  announced, 
many  years  ago,  by  Dr.  Braid,  has  recently  been 
freshly  brought  forward  through  the  experiments  of 
Fischer,'  Wiehe,^  Rieger,^  and  others.  In  our  own 
country  this  method  of  treatment  has  not  yet  been 
adopted  by  many  in  the  medical  profession,  though  its 
efficacy  in  a  particular  class  of  cases  is  not  denied. 
Outside  of  professional  circles,  however,  it  is  exploited 
to  a  considerable  extent  under  the  strange  misnomer 
of  Metaphysical  Healing.  But,  as  De  Watteville  has 
truly  remarked,'*  "the  time  is  near  when  the  curative 
influence  of  hypnotism  will  be  submitted  to  the  same 
scrutiny  as  its  physiological  and  psychological  import 
has  undergone." 

^  Op.  cit. 

'^Berlin.  Klin.   Wochensckr,  January,  1884, 

^  Der  Hypnotismiis,  Jena,  1884. 

'^  Brain,  July,  1884,  p.  278. 


THE    END. 


INDEX. 


Page. 

Acids --     71 

hydrobromic 88 

hydrochloric 72 

hydrocyanic --   100 

hydrocyanic,  in  gastric  disease  —  103 

lactic 72 

nitric 72 

nitro-muriatic,  in  hepatic  insom- 
nia  103 

phosphoric - . .     72 

Aconite 63,  93,  100 

Africa,  maladie  du  sommeil  of 30 

winds  from  the  deserts  of,  effect  of,     46 
Africans,  habits  of,  regarding  sleep  -     40 
victims  of   the  maladie   du   som- 
meil     - 30 

Alcohol 76 

effect  of ,  upon  the  brain _     54 

in  angina  pectoris 99 

in  asthma 101 

ia  chorea lio 

In  dyspepsia 103 

in  fever 10.5 

in  hepatic  diseases 102 

Allen,  Prof.  J.  Adams,  case  of  som- 
nambulism observed  by  ..- 185 

Allix,     observations    of,    regarding 

bodily  temperature  in  sleep.   ...       7 
Allix  and  Hohl,  observations  of,  re- 
garding the  pulse  in  sleep .       6 

Aloetic  purgatives  in  insanity 94 

Ammonia,  in  fever 105 

Amyl  nitrite 84 

in  angina  pectoris 99 

in  asthma --   101 

Anaemia  of  the  brain 53 

Anaesthetics 75 

Angelic  visitors,  delusions  regarding,  129 

Angina  pectoris - 99 

Anti-spasmodic     effects     of    be  la- 

donna - .- 69 

Apparent  death — 34 

crucial  test  of 35 

Arabia,  effects  of   wind   from    the 

deserts  of 46 

Arago,  observations  of,  regarding  at- 
mospheric electricity 46 

Arsenic,  in  asthma 101 

Atropia - 69 

Atropine,  use  of,  with  opiates 87 


Page. 

Aniticial  sleep,  effect   of,  upon  the 

process  of  oxidation #. 9 

mode  of  production  of 22 

Artificial   somnambulism 214 

cataleptic  form  of 219 

lethargic  form  of 220 

recollection  of  the  events  of 227 

somnambulic  form  of 222 

three  varieties  of 219 

Assafoetlda,  use  of,  in  insomnia 110 

Assimilation,  rate  of,  in  sleep 5 

Association  of  ideas,  cessation  of,  in 

sleep 3 

effect  of 123 

Asphyxia - 100 

Asthma,  insomnia  caused  by '  101 

relieved  by  atropine 69 

relieved  by  chloroform 82 

relieved  by  ether 82 

relieved  by  iodide  of  potassium...  110 

relieved  by  lobelia 71 

relieved  by  stramonium 71 

relieved  by  tobacco -- 71 

Atmo&i:)heric  electricity,  effects  of..     46 

Australia,  effect  of  winds  from  the 

deserts  of —     46 

Azam,  a  case  of  somnambulic  life  ob- 
served by —  208 

Bachelder,  Dr.  G.  H.,  observations  of, 

on  the  maladie  du  sommeil 32 

Baillarger,  hallucination  excited  by 
dreaming 126 

Ball  and  Chambard,  classification  of 
the  varieties  of  somnambulism  .  169 

Baths,  use  of,  as  nervous  stimulants,    60 

cold 73,     95 

in  fever 104 

in  insomnia 112 

in  scarlet  fever —    76 

shower 95 

warm 9'^ 

Bartholow,  on  the  use  of  phosphorus,    71 

Beard  and  Rockwell,  on  the  use  of 
electricity 62 

Beer,  effect  of 76 

Belladonna 69,  100 

use  of,  in  asthma    101 

use  of,  in  fever 104 

use  of,  in  hepatic  diseases. 102 

Bismuth,  use  of,  in  gastric  diseases.  103 


(231) 


232 


INSOMNIA. 


Page. 

Bladder,  insomnia  in  irritability  of..     90 

Blisters,  use  of,  in  rheumatism 106 

Blood,  control  of   its  circulation  by 

the  nervous  system 26 

Bombardment,  sleep  during.. 1 

Boussingault,     experiments    of,    on 
the  process  of  oxidation  in  the 

tissues -. 9 

observations  of,  on  respiration  in 

sleep 6 

observations    of,     regarding     the 

bodily  temperature  in  sleep 7 

Brain,    consequences-  of    inordinate 

excitability  of 159,  161 

exalted  receptivity  of,  during  the 

waking  state 150 

exalted   susceptibility  of,  in  sleep 

and  dreaming- ..144,  150 

the,     its    division    into     separate 

mechanisms 13 

the,  a    reservoir    of    sensory    im- 
pressions.. 124 

Brandy,  use  of,  in  wakefulness 77 

Bromide  of   potassium,    use    of,    in 

insanity 95 

of  sodium,  use  of,  in  chronic  alco- 
holism  - 97 

of    sodium,    use   of,   in   delirium 

tremens - 98 

Bromides,  the —     88 

use  of,  in  convulsions 110 

use  of,  in  delirium --     77 

use  of,  in  fever 104 

use  of,  in  night  terrors... 112 

use  of,  in    pregnancy,    and    after 

parturition - 109 

use  of,  with  chloral  and  morphia.     86 
Brooke,    Lieut.  J.  M.,  observations 
of,  regarding  hypnotic  clairvoy- 
ance -. --  224 

Bronchitis,  insomnia   caused  by 100 

insomnia  of,  relieved    with  paral- 
dehyde   80 

Brunton,  Dr.  T.  Lauder,  his  theory 

of  counter-irritation 62 

Butylchloral  hydrate   83 

iJuschick,  experience  of,  in  waking 

before  earthquakes 144 

Caffeine,  efifect  of,  upon  the  brain.     54 

Camphor    - 67 

use  of,  in  asphyxia 100 

use  of,  in  fevers 105 

use  of.  In   the  Insomnia  of  cach- 
exia    108 

use  of,  after  parturition 109 

Cannabin 69 

Cannabin  tannate 68 

Cannabis  indica 68 

anti-aphrudlsiac  effect  of 69 

use  of,  In  delirium  tremens 98 

use  of,  in  fever 104 

use  of,  in  insanity 96,    97 

use  of,  in  pregnancy 109 

use  of,  as  a  substitute    for   hyos- 

cyamus 113 

Cantharldes 6:i 

Capsicum 63 


Pagk. 


Capsicum,  use  of,  in  the  insomnia  of 

delirium  tremens 77, 

Carbolic  acid,  vapor  of,  for  relief  of 

cough  

Carbon,  oxidation  of,  during  sleep. 
Carbonic    acid    gas,    discharge    of, 

during  sleep 

Cardiac  debility,  use  of  butylchloral 

in 

Cardiac  disease,  insomnia  of,  treated 

with  paraldehyde 

treated  with  digitalis 

Cardiac  dyspnoea,  relieved  with  opi- 
ates    87, 

Cardiac  neuralgia 

Carotid  arteries,  compression  of,  for 

relief  of  insomnia. 25,27, 

Cataleptic   form   of    artificial    som- 
nambulism  

Catarrh,  nasal,  effect  of  sleep  upon. 
Caton,  Judge  John  D.,  on  .the  diffi- 
culty of   sleep   during  the  con- 
tinuous daylight   of  summer  in 

Norway 

Cerebral    activity,    effect   of,    upon 

bodily  temperature 

Cerebral  ana?mia  and  its  cause  dur- 
ing sleep ...25, 

use  of  phosphorus  for 

Cerebral  circulation,  dependence  of 

consciousness  upon 25 

during  sleep,  observations  upon,  by 

Professor  Mosso 

Cerebral    exhaustion,    benefited    by 

the  use  of  phosphorus 

in  fever 

Cerebral  hyperaemia,  effects  of 

insomnia  of,  treatment  with  paral- 
dehyde  

Cerebral  irritation  in  cachectic  states 
Cerebro-spinal     meningitis,    use   of 

opiates  in 

Cerebro-spinal  weakness 

Change  of  life,  use  of  valerian  dur- 
ing  

Chicago,  embarkation  from 

the  great  fire  in 

Child-birth,  insomnia  after 

Chl.iral 

Chloral   hydrate,  influence  of,  upon 

oxidation  in  the  tissues 

association  of,  with   morphia   and 

bromides 

use  of,  in  angina  pectoris 

use  of,  in  asthma 

use  of.  In  cachexias  with    insom- 
nia  - 

use  of.  In  chorea  

use  of,  in  chronic   alcoholism 

use  of,  in  delirium  tremens 

use  of,  in  fevers 

use  of,  in  hepatic  diseases 

use  of,  in  insanity 

use  of,  in  meningitis 

use  of,  in  night  terrors 

use  of,  in  respiratory  diseases... 
Chlorodyne 


98 
100 

9 

83 

80 
66 

98 
99 

57 

219 


40 


28 
71 

27 

26 

71 
105 
145 

80 
108 

93 
110 

68 
45 

40 
81 

82 


86 

99 

101 

109 

110 

97 

98 

104 

102 

95 

94 

112 

100 

82 


INDEX. 


233 


Page. 
Chlorodyne,  use  of,  in  syphilitic  neu- 
ralgia   107 

Chloroform 81 

use  of,  in  asthma 101 

use  of,  in  convulsions llO 

spirit    of,    in    the    treatment    of 

fevers 105 

Chossat,  observations  of,  on  the  tem- 
perature of  pigeons ? 

Circulation  of  blood,  its  regulation 

by  the  nervous  system 26 

disorders  of ..  52 

modified  by  counter-irritation 63 

state  of,  during  sleep. 6 

Clairvoyance,   hypothetical  explana- 
tion of 14S 

in  dreams 146,143,  149 

in  dreaming,  and  in  natural  som- 
nambulism.  226 

in  the  hypnotic  state 224 

Clark,  observations  of,  on  the  sleep- 
ing dropsy 30 

Codeia 85 

Codeine 88 

Coffee,  eiTects  of,  upon  the  brain 54 

Cold,  a  nervous  sedative 73 

Cold  baths-. 73 

Cold,  excessive,  a  cause  of  stupor 47 

Colic,  uterine,  relief  of 81 

Color-blindness,  effect  of  hypnotism 

upon 223 

Coma... - 32 

Coniine 91 

Conium 90,  95 

Consciousness,  duration  of  the  sensa- 
tions required  for  its  excitement  23 

state  of,  during  sleep. 14 

Convulsions,  excited  by  compression 

of  the  carotid  arteries.-..- 27 

treatment  of 110 

Cough,   spasmodic,    treatment  with 

spirit  of  chloroform 82 

Counter  irritants 62 

Crotonoil 63 

Cups,  counter  irritation  with 63,  93 

Curci,    observations    of,    regarding 

belladonna. 69 

regarding  morphia 85 

Cutaneous  disorders,  causes    of  in- 
somnia  ^ 55 

DaCosta,  onlithaemia 106 

Darkness,  favorable  to  sleep 18 

Day  andniglit,  alternation  of,  a  cause 

of  sleep 17 

Death,  apparent 84 

test  of 35 

Degeneration  of  the  brain 55 

Demme,  observations  of,  on  bodily 

temperature  in  sleep 7 

Delirium 54 

excited  by  hyoscyamus 70 

excited  by  stramonium 71 

of  exhaustion.. 77 

treatment  of,  with  musk 67 

Delirium     tremens,     treatment    of, 

with  alcohol 77 

vsrith  hrnmifies . S9 


Page. 
Delirium     tremens,     treatment    of, 

with  capsicum 77 

with  chloral 82 

with  digitalis 57 

Delusions,  caused  by  dreams I  i28 

Depressing  emotions,  a  cause  of  sleep    i» 
Diagram,  illustrating  the  stages  of 

sleep 4 

the  varieties  of  somnambulism 172 

Digitalis,    indirectly  hypnotic  effect 

of - 66 

treatment  of  delirium  tremens  with    98 
Diminution  of    energy,  represented 

by  sleepiness z 

Disease   and  dissolution,   revival  of 

memory  in 165 

Dover's  powder 67,  100,  104,  lio",  112 

Double  consciousness.  - ij04,  206 

Dreams . ng 

analysis  of 133 

at  the  moment  of  waking 14 

brevity  of. 15 

causes  of ug 

cause  of  special  vividness  of 134 

clairvoyant 146,148,  149 

coherence  of 131 

definition  of 120 

dependence  of,  upon  partial  sleep 

of  the  brain _.     i? 

duration  of 135. 

excited    by    gustatory    sensation, 

- 43,  125,  130 

byheat 43 

by  painful  diseases 141 

by  sensory  impressions  during  sleep    29 

by  sounds 41 

incoherence  of 133. 

intellectual  combinations  in.. 131 

mode  of  their  production... 124 

primitive  belief  in  the  divine  ori- 
gin of 160 

prophetic. 142,  143 

recollection  of. 140 

relation  of,  to  depth  of  sleep  . ....      4 
relation  of,  to  waking  hallucina- 
tions  , 12ft 

resemblance  of,  to  the  mental  pro- 
cesses of  insanity 133 

revival  of  memory  in 162 

somnambulic. 178 

state  of  volition  during 141 

suggested  by  externallmpulses.  125,  130 

theory  of us 

waking 123. 

Dropsy,  treatment  of,  with  digitalis.     66 
Dumontpallier,    case   of  self-hypno- 
tism related  by 219 

Duration  of  sleep no- 

Dyspnoea,  cardiac. 93 

treatment  of,  with  digitalis 66 

Dyspeptic  insomnia 104 

East  Indies,  climate  of,  a  cause  of 

insomnia 44 

Eggs,  as  an  article  of  food 66 

Electrical  test  of  apparent  death 35 

Electricity,   atmospheric _    46 

use  of 62,    6a 


234 


INSOMNIA. 


Page. 
Emphysema,   insomnia    of,   relieved 

"     with  paraldehyde 80 

Energy,  diminution  of,  represented 

by  sleepiness 2 

renewal  of,  by  sleep 5 

Epilepsy,  double  consciousness  in...  205 

Ether,  hypnotic  effect  of 81 

inhalation  of 98 

use  of ,  in  asthma 101 

use  of,  in  convulsions 110 

use  of ,  in  irritative  cough 100 

Ether,  compound  spirit  of 81 

use  of,  in  delirium  tremens 98 

use  of,  in  hepatic  diseases, 102 

Excrementitious  substances,  causes 

of  insomnia. - 55 

Exhaustion,  a  cause  of  sleep 19 

relief  of  with  alcoholic  stimulants.     76 

states  of- 64 

use  of  muskin. 68 

Exner,  experiments  of,  to  test  the 

possibility  of  dreamless  sleep...     14 
Eye,   state  of  its  secretions  during 

sleep 8 

Facial  neuralgia,  treatment  of,  with 

butylchoral 83 

Fainting,  a  counterfeit  of  sleep 25 

Fatigue,  a  cause  of  sleep 19 

Fatigue  theory  of  sleep 20 

Fevers,  eruptive,  treatment  of  with 

musk 68 

infective 57 

typhoid - 57 

treatment  of  with  cold  baths 73 

Flaxseed  tea - -  100 

Florida,  climate  of,  in  insomnia 114 

Fonssagrives,    observations    of,    re- 
garding atmospheric  electricity 

and  insomnia 46 

Food,  lack  of,  a  cause  of  insomnia..     63 
Foot-baths,  hot,  in  the  treatment  of 

insomnia 93,     94 

Force,  fluctuations  of 15 

kinetic >5 

potential 15 

Frank,  J.  P.,  case  of  somnambulism 

related  by - 195 

Functional  nervous  disorders,  treat- 
ment of  with  hypnotism 229 

Gairdner,  W.  T.,  case  of  somnambu- 
lic lethargy  reported  by -.   174 

Gastro-intestinal    glands,    state     of 

their  secretions  during  sleep 8 

Gelsemium 90 

treatment  of  fever  with 104 

use  of,  in  the  wakefulness  of  chil- 
dren    112 

Generation  of  Ideas,  relation  of,  to 
molecular    movements   in     the 

brain 24 

Grasset,  case  of  somnambulism  re- 
lated by I"? 

Gu^rln,  observations  of,  on  the  mala- 

die  du  sonimeil 30 

Guiana,  delusions  among  the  Indians 

of,  founded  upon  dreams 128 

travels  in 42 


Page. 
Guy,  observations  of,  regarding  the 

pulse  in  sleep 7 

Hallucination,  case  of,  related  by  Dr. 

E.H.  Clarke 156 

experienced  by  Sir  Edmund  Horn- 
by  150 

prQduction  of,  by  drugs 120 

sometimes  excited  by  dreams.  126,  150 
Hamilton,  Sir  William,  experiments 
of,  on  the  possibility  of  dreamless 

sleep 14 

Hasheesh,  visions  excited  by 120 

Hayes,  Dr.  P.  S  ,  case  of  lucid  leth- 
argy reported  by 35 

Headache - 54 

Hearing,  persistence  of  during  sleep,     41 

sense  of,  during  sleep 11 

Heat,  a  cause  of  insomnia .     44 

a  nervous  stimulant 59 

effects  of  excessive 47 

liberation  of,  during  sleep 9 

Heart,  pulsation  of,  in  sleep 6 

Heldenhain,  observations  of,  on  hyp- 
notism  214 

Helmholtz,  observations  of,  on  lib- 
eration of  heat  during  sleep 9 

Hemicrania,  treatment  of, with  butyl- 
chloral 83 

Henneberg,  experiments  of,  on  oxi- 
dation in  the  tissues  9 

Hibernation,  phenomena  of 48 

Hoffmann's  anodyne 81 

Hohl   and  Allix,  observations  of,  on 

the  pulse  in  sleep... .-      6 

Holland,  Sir  Henry,  observations  of, 
regarding  the  loss    of    memory 

during  exhaustion 209 

Hops 90 

treatment  of    chronic    alcoholism 

with --- 97 

Hornby,     Sir    Edmund,    experience 

of  hallucination 150 

Horsford's  Acid  Phosphate 72 

Horvath,  observations  of,  on  the  tem- 
perature of  hibernating  mar- 
mots         8 

Hunger 2 

Hydrobromic  acid 88 

Hydrochloric  acid,  useful  in  atonic 

dyspepsia 72 

Hydrocyanic  acid 100 

In  gastric  diseases. 103 

Hyosciamia 70,     96 

Hyosciamine 70 

Hyoscyamus 70 

use  of,  after  parturition 109 

use  of,  in  astlima 101 

use  of,  in  fever 104 

use  of.  in  hepatic  diseases... 102 

use  of,  in  Insanity 96 

use  of.  In  insomnia  of  children 112 

use  of,  in  renal  diseases. 102 

Hyperaemia  of  the  brain 52,  54,  110 

Hypnagogic  hallucinations 3,       4 

Hypnagogic  state 2 

Hypnotic  sleep,  duration  of 217 

Hypnotic  sleep,  clairvoyance  in 224 


INDEX. 


235 


Pa&e. 

Hypnotic    sleep,    condition    of    the 

special  senses  in 223 

conditions  favorable  to 214 

exaltation  of  the  imitative  faculty 

during 227 

methods  of  inducing. 215 

perception  during 149 

Hypnotism 214 

likeness  of,  to  somnambulism 203 

observations  of  Braid.- 214,  229 

observations  of  Charcot.. 214,  219,  221 

observations  of  Gohn. 223 

observatidns  of  De  Watte ville 229 

observations  of  Dumontpallier.219,  221 

observations  of  Fischer 150,  227 

observations  of  Harting 215 

observations    of    He.denhain,  214, 

215,    216,  222 

observations  of  Milne-Edwards 215 

observations  of  Rieger 229 

observations  of  Wiehe 229 

receptivity  of  the  brain  to  sugges- 
tions during.. 226 

suggestion  of  ideas  during 226 

therapeutical  use  of 228 

Hysteria,  a  cause  of  double  conscious- 
ness   205 

Hysterical  excitement,  treatment  of,     68 
Ice-cap,   in  the  treatment  of  acute 

affections  of  the  brain 93 

Iceland  moss,  for  the  relief  of  cough,  100 
Ideas,  their  dependence  upon  mole- 
cular movements  in  the  brain..     24 
Illusions,  excited  by  disease  and  by 

drugs 120,  122 

Imagination,  persistence  of,  in  sleep,       3 
Imitative  faculties,  exaltation  of,  in 

hypnotic  states -..  227 

Immermann,  on  cold  baths 73 

Impulses    to  violence    during    som- 
nambulism  - 193 

Im  Thurn,  Everard  F.,   on   dreams 

among  the  Indians  of  Guiana 128 

Indians,  of  Guiana,  magic  practices 

among 42 

Inflammations  affecting  the  brain 54 

Inhalations,  medicated.. 100 

Injuries  of  the  brain ...'. 55 

Insanity 54,  57,70,  133 

Insomnia 38 

Insomnia,  causes  of 39 

caused  by  aortic  obstruction 84 

caused  by  asthma 101 

caused  by  cardiac  disorders 51 

caused  by  cold 47 

caused  by  contagia  of  animal   ori- 
gin  -- 55 

caused  by  cutaneous  disorders. 49,     55 

caused  by  dyspepsia 51 

caused  by  electrical  disturbances.    46 
caused    by   excrementitious     sub- 
stances  55 

caused  by  fatigue 78 

caused  by  heat 44,     46 

caused  by  heat  and  humidity 44 

caused  by  icterus 49 


Page. 

Insomnia,  caused  by  inflammations.  50 

caused  by  insects 49 

caused  by  itching  in  myelitis 49 

caused  by  itch-mite 49 

caused  by  light 39 

caused  by  malaria 72 

caused  by  meningitis 50 

caused  by  miasms 55 

caused  by  morbid  states  of  the  cen- 
tral nervous  organs 51 

caused  by  neuralgia 50 

caused  by  neuritis 50 

caused  by  neuromata 50 

caused  by  oxaluria 72 

caused  by  pain 49 

caused  by  parasites 49 

caused  by  periostitis 50 

caused  by  phosphatic  diathesis 72 

(paused  by  pneumogastric  disorder.  51 

caused  by  poisons 55 

caused  by  products   of    putrefac- 
tion     ...   55 

caiJsed  by  respiratory  disorders...  51 

caused  by  rheumatic  diathesis 72 

caused  by  sounds 41 

caused  by  smells .-. 42 

caused  by  stramonium 71 

caused  by  sympathetic  nerve  dis- 
order   50 

Insomnia,  occurrence  of,  after  child- 
birth....   81 

occurrence  of,  after  parturition...  109 
occurrence  of,  during  acute  affec- 
tions of  the  brain 92 

occurrence  of,  during  bronchitis..  80 
occurrence  of,  during  cardiac  dis- 
eases   66,80,  87 

occurrence   of,  during  change  of 

life  in  women 84 

occurrence  of,  dtiring  childhood 110 

occurrence  of,  during  chorea 110 

occurrence  of,  during  chronic  alco- 
holism   97 

occurrence     of,      during    chronic 

phthisis 84 

occurrence    of,     during    delirium 

tremens 87,90,  97 

occurrence  of,   during  diseases  of 

the  heart  and  blood-vessels 98 

occurrence  of,  during  diseases  of 

the  liver 102 

occurrence  of,  during  diseases  of 

the  respiratory  organs 99 

occurrence  of,  during  disorders  of 

nutrition 107 

occurrence   of,  during    dysmenor- 

rhoea 84 

occurrence  of,  during  emphysema,  80 
occurrence  of,  during  febrile  con- 
ditions and  fevers 87,  104 

occurrence  of,  during  gastric  and 

intestinal  disorders ...87,  103 

occurrence    of,   during    gout   and 

rheumatism . -- 103,  107 

occurrence  of,  during  headache..  84 

occurrence  of,  during  hysteria. 81,  89 


236 


INSOMNIA. 


,                     Page. 
Insomnia,  occurrence  of,  during  in- 
sanity       94 

occurrence  of,  during  irritability  of 

the  bladder 90 

occurrence  of,  during  irritability  of 

the  sexual  organs 90 

occurrence    of,    during    irritative 

dyspepsia 90 

occurrence  of,  during  jaundice 80 

occurrence  of , during  lithaemia,106,  107 
occurrence  of,  during  mania, 87,  89,     90 
occurrence  of,  during  melancholia,     96 
occurrence  of,  during  mental  ex- 
haustion      89 

occurrence  of,  during  nervous  dis- 
orders - 80 

occurrence  of,  during  neuralgia...     84 
occurrence  of ,  during  old  age. .78,  113 
occurrence  of,  during  opium  habit,     84 
occurrence   of,  during  paretic  de- 
mentia       96 

occurrence  of,  during  phthisis.. 80,  87 
occurrence  of,during  pregnancy, 89,  109 
occurrence  of,  during  the  puerperal 

state 89 

occurrence  of,  during   renal   dis- 
eases  101 

occurrence  of,  during  rheumatism 

and  gout.... 105,  107 

occurrence  of,  during  sexual  excite- 
ment  - 89 

occurrence  of,  during    spasmodic 

diseases 109 

occurrence  of,  during  states  of  ex- 
haustion  67 

occurrence  of,  during  syphilis.  106,  107 
Insomnia,   relation  of,  to   states   or' 

the  cerebral  circulation 57 

relief  of,   by  compression  of  the 

carotid  arteries 25 

Iodide   of    potassium,    treatment  of 

asthma  with 110 

Ipecac,  treatment  of  asthma  with...  101 

Irritability  of  the  brain 53,     54 

Itching  of  eczema,  relieved  with  can- 
nabis indica 69 

Jacobi,  A.,  on  wakefulness  of  chil- 
dren    Ill 

Japanese,  use  of  massage  among 61 

Jaundice,     insomnia    of,    treatment 

with  paraldehyde 80 

Jessen,  case  of  hallucination  caused 

by  dreaming 127 

Joseph,  St.,  dreams  of 142,  160 

Judgment,     suspension    of,    during 

sleep _. 3 

Kohlschiitter,    experiments    of,     to 

measure  the  depth  of  sleep 16 

Koumiss 64 

Lactic  acid,  hypnotic  effects  of 72 

Lactate  of  sodium,  hypnotic  efifects 

of 20,    72 

Lactucarlum 88 

Latent  contracture 221 

Leeches,  use  of 63,  93,    94 

Lethargic  form  of  artificial  somnam- 
bulism   -- 220 


Pagb. 
Lethargy 33 

produced  by  excessive  cold 48 

Lewin,   observations  of,  on  respira- 
tion during  sleep 6 

experiments   of,    on    oxidation  in 

the  tissues 9 

Llebermeister,  experiments  of,  on  ox- 
idation in  the  tissues 9 

Life,  normal 4 

possibility   of  intermissions  in  its 

active  manifestation. 15 

Light,  interfc!  ence  of,  with  sleep,40,    41 

Liquors,  effects  of.. 76 

Lithaemia,  a  cause  of  insomnia 106 

Lithium  bromide 88 

Lobelia,  anti-spasmodic  effects  of,  71,  101 

Lomi-lomi 61 

Lucid  lethargy 35 

contrasted  with  somnambulic  leth- 
argy   176 

Lupulin 90 

Macario,    case    of     somnambulism, 

reported  by ._  192 

Mackinac,  voyage  to 45 

Macnish,  case  of  somnambulic  life, 

reported  by  .-. 206 

Maladie  du  sommeil 30 

Malaria,     treatment    of    insomnia, 

caused  by 72 

Mania,  use  of  chloral  in 82 

Marmot,  hibernation  of 48 

temperature   of,    during    hiberna- 
tion  8 

Massage 60,  109 

Matter    and    mind,    communication 

between 22 

Maury.  A.,  classification  of  the  vari- 
eties of  somnambulism 168 

experience  of,  with  table-rapping.  228 
theory  of,  regarding  forgetfulness 
of  the  events  of  somnambulism.  211 

Measles,  use  of  baths  in 74 

Meat  juice. 66 

Memory,  effect  of  physical   exhaus- 
tion  209 

exaltation  of,  in  somnambulism 187 

persistence  of,  in  sleep 3 

relation  of,  to  phenomena  of  som- 
nambulism  192 

revival  of,  during  disease  and  dis- 
solution  165 

revival  of,  during  dreaming 162 

Meningitis 54,     57 

Mental  activity  during  sleep 14 

Mesnet,   case  of   somnambulism  re- 
lated by  196 

Metaphysical  healing 229 

Michigan,  Lake,  voyage  upon.  45 

Northern,      summer    climate    of, 

favorable  to  sleep 45 

Milk,  peptonized 64 

Mind  and  matter,  communication  be- 
tween     22 

alternate  states  of  action  and  re- 
pose       15 

sleep  of -     15 

state  of,  during  sleep 14 


INDEX 


237 


Page. 

Miad-readiiig 218,  227 

Minnesota,  summer  climate  of,  favor- 

ableto  sleep 45 

Mitchell,  S.  Weir,  observations  of, 
regarding  effect  of  variable  bar- 
ometric pressure .- 47 

Molecular  movement,  its  relation  to 

the  generation  of  ideas 24 

Moral  responsibility  in  somnambu- 
lism    203 

Morphia.. 97,  98,  100,  101 

Morphine,  influence  of,  on  oxidation 

in  the  tissues 10 

Mosso,  Professor,  on  the  circulation 

of  blood  during  sleep 26 

on  respiration  during  sleep 5 

Mouth,  condition  of ,  during  sleep...       8 

Muscles,  effect  of  sleep  upon 12 

fibrillary      twitching    of,     during 

sleep 3 

Muscle-reading 218 

Musk.. 67,  100,  105 

Mustard 63 

Nasal    catarrh,     state    of    secretion 

during  sleep 8 

Narcotic  stupor 29 

Nerves,  of  common  sensation,  affec- 
tions of 89,    49 

pneumogastric 51 

sympathetic,  affections  of,  causes 

of  insomnia 50 

Nervous  disorders,  insomnia  of,  re- 
lieved with  paraldehyde 80 

hypnotic  treatment  of 229 

Nervous  irritation,  effect  of,  on  tis- 
sue change 10 

sedatives 58,     59 

stimulants 58,     59 

system,  its  control  over  the  circu- 
latory apparatus 26 

Neuralgia,  cardiac 99 

treatment  of,  with  alcohol 77 

treatment  of,  with  belladonna 69 

treatment  of,  with  preparations  of 

valerian 68 

Neurasthenic  patients 66 

New  Providence,  climate  of,  benefi- 
cial in  insomnia 114 

Night  and  day,  alternation  of,  a  cause 

of  sleep 17 

Night  terrors 179 

treatment  of 89,  112 

Nitric  acid 72 

Noctambulism. 169 

Noise,  sleep  prevented  by 41 

North  China  Herald,  criticism  of  Sir 

E.  Hornby's  narrative 155 

Norway,  difficulty  of  sleeping  during 

the  summer 40 

Nutrition,  effect  of  sleep  upon 5,      9 

disorders  of 52 

Obersteiner,  his  theory  of  sleep 20 

Odors,  effect  of,  upon  sleep 11 

Old  age,  decline  of  life  in 113 

Omphaloscopy _ 217 

Opii;m  and  opiates 84,     98 


Page. 
Opiates,  use  of,  in  treatment  of  ca- 
chexias  _  108 

use  of ,  in  treatment  of  fever. . .  104,  105 
use  of,  in  treatment  of  gastric  dis- 
ease   103 

use  of,  in  treatment  of  insanity...     96 
use  of,  in  treatment  of  renal  dis- 
eases  102 

use  of,  in  treatment  of  rheuma- 
tism   105 

Oxaluria,  insomnia  caused  by 72 

Oxygen,  absorption  of ,  during  sleep.       9 
Ozone,  use  of,  in  the  treatment  of 

asthma 101 

Pacific  Islanders,  habits  of,  regard- 
ing sleep  in  the  daytime 40 

use  of  massage  among 61 

Pain,  a  cause  of  sleep 19 

Paraldehyde ...79,  95,  97,  108 

Paregoric 100 

Perception,  effect  of,  upon  nervous 

tissue 10 

duration  of,  necessary  to  arouse 

consciousness 23 

range  of,  circumscribed  by  sleep..     12 
transfer  of,  in  telepathy  and  hyp- 
notism   217 

Percussion 61 

Perspiration,    secretion    of,    during 

sleep 9 

Pettenkof er,  experiments  of,  on  oxi- 
dation in  the  tissues 9 

experiments  of,  on  respiration  in 

sleep 6 

Pettenkofer     and     Voit,    on     tissue 

changes _ 10 

Pfliiger,  hypothesis  of,  regarding  the 

cause  of  sleep 21 

Phosphatic  diathesis,  a  cause  of  in- 
somnia  72 

Phosphoric  acid 72 

Phosphorus 71 

Phthisis,  coagh  of,  relieved  with  lac- 

tucarium 88 

Insomnia  of,  relieved  with  paralde- 
hyde   - 80 

treatment  of,  with  opiates 87 

Physiological  activity,  reduction  of, 

during  sleep 5 

Physiological  cause  of    somnambu- 
lism  ISO 

Planchette-writing 228 

Pleuritic  pain 99 

Pneumogastric      nerves,      insomnia 

caused  by  affections  of 51 

Pneumonia 68,  100 

Porter,  effects  of 76 

Potassium  bromide 88 

Preyer,  his  theory  of  sleep 20 

Psychical  Research,  Society  for,  In- 
vestigations by 149,  217 

Pulse,  state  of,  during  sleep 6 

Punkah,  use  of,  to  promote  sleep 44 

Quetelet,  observations  of,  on  respi- 
ration during  sleep -      5 

Quinine  and  opium,  use  of,  in  fever.  104 


238 


INSOMNIA. 


Page. 

Reasoning  powers,  arrest  of,  during 
sleep 3 

Recollection  of  the  events  of  artifi- 
cial somnambulism 227 

of  the  events  of  natural  somnam- 
bulism     188 

Reflex  movements  during  sleep. 12 

Refrigeration,  threefold  effect  of 49 

Relation  between  molecular  move- 
ment and  the  generation  of  ideas    24 

Respiration  during  sleep 5 

Revelation  through  dreams 160 

Revery,  nature  of .  120 

Rheumatic  diathesis,  a  cause  of  in- 
somnia  72 

Rosenthal,  observations   of,   regard- 
ing lethargy 33,     34 

observations    regarding    apparent 

death — 35 

Rush,  Dr.,  observations  of,  on  the  re- 
vival of  memory  in  dissolution. .  165 
Sailors,  sleeping  during  a  bombard- 
ment.  - 1 

Sailor-boy,  sleeping  on  a  mast 1 

Salicylic  acid,  treatment  of  rheuma- 
tism with 106 

Saliva,  secretion  of,  during  sleep 8 

Samuel  the  prophet,  dream  of. 129 

Sandwich  Islands,  climate  of,  for  re- 
lief of  insomnia 114 

Scarlet    fever,    treatment    of,    with 

baths 74,     75 

Scharling,  observations  of,  regarding 
bodily  temperature  during  sleep.      7 
experiments  of,  on  oxidation  In  the 

tissues 9 

Screaming  fits  of  children 112 

Secretion,  state  of,  during  sleep 8 

Sedatives,  nervous ..59,    73 

Self-hypnotism 219 

Sensory  excitement,  effect  of,  upon 

the  cerebral  circulation 27,     28 

Sensory  organs,  condition  of,  during 

somnambulism 191 

Sfcxual  organs,  irritability  of 90 

Shampooing 61 

Simon,  P.   Max,  case  of  somnambu- 
lism related  by 182 

dream  related  by .  - 142 

Sleep,  affected  by  certain  winds 45 

artificial,  mode  of  its  production..     22 
caused  by  the  alternation  of  day 

and  night 17 

caused  by  depressing  emotions 19 

caused  by  exhaustion 19 

caused  by  fatigue 19 

caused  by  painful  Impressions 19 

caused  by  the  venereal  act 19 

definition  of 1 

dreamless 14 

duration  of 4,  110 

effects  of  its  invasion  upon  the  in- 
tellectual faculties 13 

effect  of ,  upon  consciousness... 13,     14 

fatigue  theory  of 20 

favored  by  darkness 18 


Page. 
Sleep,  favored  by  the  suppression  of 

sensation is 

hindered  by  heat 44 

hindered  by  light 39 

hindered  by  smells 42 

hindered  by  sounds 41 

introductory  stage  of 2 

invasion  of 10,  117 

measure  of  its  depth  by  the  experi- 
ments of  Kohlschiitter 16 

-  Obersteiner's  theory  of 20 

Pflliger's  hypothesis  regarding  the 

cause  of 21 

proceeded  by  sleepiness 2 

Preyer's  theory  of 20 

rapid  Induction  of,  in  certain  cases    24 
relation  between  the  duration  of, 
and  the  average  length  of  the 

night 17 

stages  of 4 

tlie  cause  of 29 

unequal  incidence  of,  upon  differ- 
ent portions  of  the  brain 13 

Sleep-drunkenness. 180,  181 

Sleepiness,  precursive  of  sleep. 2 

Sleeping  dropsy 30 

Sleeplessness,  causes  of 39 

Smells,  abolition  of  sleep  by 42 

Smile,  during  sleep 12 

Smith,  E.,  experiments  of,  on  oxida- 
tion in  the  tissues 9 

Snoring,   occasional   interruption  of 

sleep  by 11 

Society  for  Psychical  Research,  in- 
vestigations by 149,  217 

Sodium  bromide 8-i 

Somniation 169 

Somnambulic  dreams 171,  178,  181 

recollections  of 188 

Somnambulic  form  of  artificial  som- 
nambulism   222 

Somnambulic  lethargy 171,  173 

contrasted  with  lucid  lethargy 176 

Somnambulic  life... 169,  204 

a  case  of 206 

a  case  of,  related  by  Azam 208 

a  case  of,  related  by  Macnish 206 

Somnambulism. 166 

artificial 214 

case  of,  related  by  Prof.  J.  Adams 

Allen 185 

case  of,  related  by  J.  P.  Frank 195 

case  of,  related  hy  Macarlo 192 

case  of,  related  by  Mesnet ..  196 

case  of,  related  by  P.  Max  Simon.  1S2 

causes  of 166 

condition  of  sensory  organs  during.  191 
dependence  of,  upon  partial  sleep 

of  the  brain 11 

likeness  of,  to  hypnotism 203 

moral  responsibility  In 203 

phenomena  of 167,  210 

physiological  cause  of 180 

relation  of  memory  with    events 

of 192 

varieties  of,  according  to  A.  Maury,  16& 


IJ^DEX. 


289 


Page. 
Somnambulism,  varieties  of,  accord- 
ing to  Ball  and  Chambard 169 

varieties  of,  diagrammatically  ex- 
hibited-     ..1T2 

violent  impulses  during 193 

Somnolence 30 

Somnolentia  180,  181 

Sound,  effect  of,  to  hinder  sleep 42 

effect  of,  to  induce  sleep 42 

Spasmodic  croup 110 

Special  sense  organs,  affections  of  ..     39 
Special  senses,  condition  of,  during 

invasion  of  sleep 11 

perversion  of,  during  the  hypnotic 

state - 223 

Spinal  cord,  irritability  of 110 

reflex  energy  of,  during  sleep 3 

Spinal  irritation 62 

Spirit  of  chloroform 81 

Spiritual  circle,  manifestations  in  ..  227 

Stewart,  Dugald,  observation  of 43 

Stimulants  after  parturition 109 

in  fever 105 

nervous  -. 59 

Stramonium 70,  101 

Striimpell,  observations  of,  regard- 
ing sleep  produced  by  suppression 

of  sensation 18 

Strychnia 105 

Stupor  produced  by  excessive  heat  or 

cold 47 

Subsultus   tendinum,    treatment  of, 

with  musk 67 

Suction,  involuntary,  during  infantile 

sleep .-_ 12 

Suppression  of  sensation,  a  cause  of 

sleep _ 18 

Swedish  movement  cure 61 

Sympathetic  nerves,  affections  of,  39,     50 
Table-rapping,  method  of  communi- 
cation in 228 

Tannate  of  cannabin 68 

Tartar  emetic,  use  of,  in  asthma 101 

use  of,  in  delirium  tremens 98 

use  of,  in  fever 104 

use  of,  with  opium 108 

Taste,  relation  of,  to  insomnia .     43 

Tea,  effect  of,  upon  the  brain. 54 

Telegraphy  without  a  wire,  through 

water 147 

Telepathy,  investigation  of,  by  the 

Society  for  Psychical  Kesearch.  149 
Temperature,  of    the  body,   during 

sleep 7 

sense  of 43 

Thapsia 63 

Theory  of  sleep,  Obersteiner'  s 20 


Page. 

Theory  of  Sleep,  Pfliiger's 21 

Preyer'^s _.  20 

Thirst ..    .- 2 

Thompson,  Sir  William,  his  doctrine 

concerning  a  sixth  sense 43 

Tickling,  effect  of  during  sleep 14 

Tobacco,  anti-spasmodic  effect  of,  71, 

99,  101 

Transfer  of  perceptions 217 

Trousseau,   observations  of,  on  the 

pulse  during  sleep 6 

Tuberculosis  of  the  cerebral  mem- 
branes   55 

Tully's  Powder 67 

Tumors  of  the  brain 55 

Turkish  baths 60 

Turpentine 6S 

Typhoid  fever,  insomnia  during 64 

treatment  of,  with  baths 74 

treatment  of,  with  musk 68 

treatment  of,  with  Tully's  Powder,  67 
Typhus    fever,   treatment    of,  with 

musk 68 

Unconsciousness,   produced  by  com- 
pression of  the  carotid  arteries..  27 
relation  of,  to  modifications  of  the 

cerebral  circulation 25 

Urea,  elimination  of,  during   sleep..  9 

Urine,  secretion  of,  during  sleep 9^ 

Uterine  colic 81 

Valerian 68,  109 

Valerianate  of  ammonia 68 

of  zinc - 68 

Venereal  act,  a  cause  of  sleep 19 

Vierordt,    observations    of,    on    the 

duration  of  sleep 110 

Visions,  character  of. 119 

of  the  ancient  prophets 161 

Voit,  observations  of,  on  oxidation  in 

the  tissues 9 

on  respiration  during  sleep 6 

Volition,  cessation  of,  during  sleep..  3 

Wakefulness 38 

causes  of 39 

dependence  of,  upon   instability  of 

cerebral  protoplasm 22 

Warburton,  Rev.  Canon,  clairvoyant 

dream  of - 146 

Weariness,  a  cause  of  sleep 1 

Wharton  and  Stille,  on  sleep-drunk- 
enness ...'. 181 

Whooping-cough,  treatment  of,  with 

belladonna 69 

Wind,  effect  of,  upon  sleep 45 

Wine,  effects  of 76 

use  of,  in  the  insomnia  of  old  age.  78 

Ziemssen,  von,  on  the  use  of  baths.-  73 


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